| Introduction |
 Common foot deformity seen with
- spastic diplegic and quadriplegic cerebral palsy
- fibular hemimelia
- Deformity consists of
- midfoot abduction
- heel valgus
- equinus contracture
- typically bilateral
- Muscle imbalance includes (see overview of foot deformity muscle imbalances)
- spasticity of
- peroneals
- gastoc-soleus complex
- weakness of
- ligamentous laxity
- posterior tibialis
- anterior tibialis
- Biomechanics
- creates lever arm dysfunction during gait and ankle rocker function
- patient is bearing weight on the medial border of the foot and talar head
- external rotation of the foot creates instability during push off
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| Presentation |
- Symptoms
- painful callus over talar head secondary to weightbearing
- abnormal shoe wear
- Physical exam
- typically seen bilaterally
- valgus heel deformity seen when viewing feet from posterior
- the heel valgus deformity must be manually corrected first before testing for achilles contracture
- a valgus heel can mask an equinus contracture by allowing a shortened path for the achilles
- prominent talar head appreciated in the arch
- compensatory midfoot supination is typically seen
- midfoot break occurs in attempt to keep foot plantigrade
- hallux valgus typically develops over time
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| Treatment |
- Nonopeative
- bracing and physical therapy
- indications
- technique
- ankle foot orthosis or supramalleolar orthosis
- botox injections
- Operative
- calcaneal osteotomy with soft tissue procedure
- indications
- technique
- soft tissue procedures
- TAL
- peroneus brevis lengthening
- bony procedures
- calcaneal osteotomy
- medial slide ostetomy or calcaneal lengthening osteotomy
- lateral column lengthening procedure
- performed through calcaneus or cuboid
- Grice procedure
- extra-articular subtalar arthrodesis
- place ICBG in lateral subtalar joint to block valgus
- does not interfer with tarsal bone growth
- subtalar arthroeresis
- stabalizes subtalar joint in correct alignment without fusion
- implant or spacer is placed laterally in the subtalar joint to prop open
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