| Introduction |
 Common foot deformity seen with
- cerebral palsy (usually spastic hemiplegia)
- Duchenne muscular dystrophy
- residual clubfoot deformity
- tibial deficiency (hemimelia)
- Muscle imbalance includes
- spasticity of
- tibialis posterior and/or tibialis anterior
- gastoc-soleus complex
- absence of ligamentous laxity
- foot deformity muscle imbalance overview
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| Presentation |
- Symptoms
- painful weight bearing over the lateral border of the foot
- instability during stance phase
- Physical Exam
- gait analysis
- diagnosis made with gait analysis showing
- overactivity of tibialis posterior and/or
- overactivity of tibialis anterior
- confusion test
- helps to distinguish AT vs PT as the primarily involved muscle
- patient performs active hip flexion against resistance while seated
- in a positive confusion test, the tibialis anterior fires with active hip flexion and is typical in patients with CP
- if the foot supinates with dorsiflexion, tibialis anterior is most likely contributing to the equinovarus deformity
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| Treatment |
- Nonoperative
- Operative
- TAL with tibialis posterior split transfer to peroneus brevis
- indications
- spastic hemiplegia in patient ages 4 to 7
- flexible equinovarus hindfoot
- tibialis posterior spastic in both stance and swing phase (continous activity)
- technique
- reroute half of tendon dorsally and insert into peroneus brevis
- Rancho procedure
- indications
- overactive anterior tibialis
- flexible equinovarus deformity
- technique
- split anterior tibialis transfer to cuboid with TAL and intramuscular lengthening of the posterior tibial tendon
- Calcaneal osteotomy
- indications
- is required in a rigid hindfoot varus deformity
- technique
- lateral closing wedge osteotomy to incur valgus to the heel
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