summary Foot Conditions are the most common deformity seen in Cerebral Palsy which are caused by lower extremity spasticity and can take several forms including equinus, hallux valgus, equinocavovarus, and equinoplanovalgus. Diagnosis is made clinically with presence of spasticity/contracture of the gastrocsoleus complex in equinus, presence of a spastic hallux valgus, and supination deformities of the midfoot and forefoot. Treatment is usually bracing and shoe modifications for mild and flexible conditions. Surgical management is indicated for progressive deformities that are not amenable to bracing. Etiology See Cerebral Palsy General Foot deformities are common in cerebral palsy and may take several forms including Equinus Hallux Valgus EquinoPlanoValgus EquinoCavovarus Equinus Epidemiology most common deformity in cerebral palsy Pathophysiology imbalance of ankle dorsiflexors and plantarflexors, resulting in plantar flexion of the hindfoot relative to the ankle, with normal mid- and forefoot alignment spasticity/contracture of the gastrocsoleus complex Presentation symptoms shoe fitting / wear and tear tripping secondary to poor foot clearance instability due to decreased base of support physical exam inspection login to view 4 more bullets motion login to view 1 more bullet provacative tests login to view 3 more bullets Imaging radiographs not required unless other pathology present (hindfoot malalignment) Treatment nonoperative serial manipulation and casting login to view 2 more bullets botulinum toxin A intramuscular injection into gastrocnemius login to view 4 more bullets articulated or hinged AFO login to view 4 more bullets solid AFO login to view 4 more bullets operative tendo-Achilles lengthening (TAL) versus gastrocnemius recession login to view 4 more bullets Techniques Gastrocnemius recession approach login to view 1 more bullet soft tissue login to view 5 more bullets outcomes login to view 1 more bullet Tendo-Achilles lengthening (TAL) approach login to view 1 more bullet soft tissue login to view 4 more bullets Hallux Valgus Epidemiology most common in diplegics with equinus and planovalgus feet associated with equinovalgus and external tibial torsion Pathophysiology caused by combination of adductor hallucis overactivity and externally applied forces, such as inadequate clearance resulting from equinovalgus deformity, forcing the great toe into valgus. Presentation symptoms pain and difficulty wearing proper shoes physical exam inspection login to view 2 more bullets Imaging radiographs recommend views login to view 1 more bullet findings login to view 1 more bullet Treatment nonoperative observation login to view 2 more bullets operative first metatarsophalangeal joint arthrodesis login to view 5 more bullets proximal phalanx (Akin) osteotomy login to view 2 more bullets Techniques EquinoPlanoValgus Epidemiology incidence common foot deformity seen with cerebral palsy (spastic diplegic and quadriplegic) location typically bilateral Pathophysiology equinus with pronation deformity pathomechanics due to comination of spastic peroneal muscles, weak posterior tibialis, spastic heel cord in ligamentous laxity foot creates lever arm dysfunction during gait leads to bearing weight on the medial border of the foot and talar head external rotation of the foot creates instability during push off Presentation symptoms painful callus over talar head secondary to weight-bearing shoe wear problems physical exam inspection login to view 5 more bullets motion login to view 2 more bullets Imaging Radiographs recommended views login to view 1 more bullet findings login to view 3 more bullets Treatment Nonoperative bracing login to view 2 more bullets Operative bony and soft tissue procedures login to view 11 more bullets Techniques calcaneal osteotomy and lateral lengthening approach login to view 1 more bullet bone work login to view 2 more bullets instrumentation login to view 1 more bullet complications login to view 1 more bullet Grice procedure approach login to view 1 more bullet soft tissue login to view 1 more bullet bone work login to view 2 more bullets outcomes login to view 1 more bullet subtalar arthroereisis approach login to view 1 more bullet bone work login to view 1 more bullet outcomes login to view 1 more bullet complications login to view 1 more bullet Complications overcorrection into varus most common complication sural nerve injury at risk during calcaneal osteotomy procedures overlengthening of lateral column results in a painful lateral forefoot secondary to overload EquinoCavoVarus Epidemiology more common in spastic hemiplegia Pathophysiology equinus deformity of the hindfoot coupled with supination deformities of the midfoot and forefoot pathomechanics invertors (posterior tibialis and/or anterior tibial tendons) overpower evertors (peroneal tendons) creates lever arm dysfunction during gait disrupts the second rocker by blocking ankle dorsiflexion and compromises stability function in midstance shortens the length of the plantar flexor muscles, compromising their ability to generate tension Presentation symptoms painful weight-bearing shoe wear issues physical exam inspection login to view 2 more bullets motion login to view 3 more bullets Imaging radiographs recommended views login to view 1 more bullet findings login to view 2 more bullets Treatment nonoperative bracing login to view 3 more bullets operative soft tissue balancing login to view 12 more bullets bony procedures login to view 8 more bullets Technique split posterior tibial tendon transfer (SPOTT) approach login to view 2 more bullets soft tissue login to view 4 more bullets outcomes login to view 1 more bullet split anterior tibialis tendon transfer (SPLATT) approach login to view 1 more bullet soft tissue login to view 3 more bullets calcaneal osteotomy approach login to view 1 more bullet bone work login to view 2 more bullets instrumentation login to view 1 more bullet triple arthrodesis approach login to view 2 more bullets bone work login to view 3 more bullets instrumentation login to view 1 more bullet complications login to view 1 more bullet Complications Deformity recurrence failure to recognize and address all components