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Split posterior tibial tendon transfer is used in the treatment of children with cerebral palsy. Which of the following patients is considered the most appropriate candidate for this procedure?
A 6-year-old child with athetosis and a flexible equinovarus deformity of the foot
A 6-year-old child with spastic hemiplegia and a rigid equinovarus deformity of the foot
A 6-year-old child with spastic hemiplegia and a flexible equinovarus deformity of the foot
A 10-year-old child with spastic quadriplegia and rigid valgus deformities of the feet
A 15-year-old child with spastic diplegia and rigid equinovalgus deformities of the feet
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Figure 12 shows the radiograph of a 15-year-old boy with cerebral palsy who has pain at the first metatarsophalangeal joints. He is a community ambulator. Management consisting of accommodative shoes has failed to provide relief. What is the treatment of choice?
Custom-molded night orthotics
Double osteotomy of the first metatarsals
Crescentic osteotomy of the first metatarsals
Distal realignment (modified McBride)
First metatarsophalangeal joint arthrodeses
A 5-year-old male presents to your office for continued evaluation of a right equinocavovarus foot. He has a known history of spastic hemiplegic cerebral palsy and has failed conservative management including bracing. On exam, he has stage 2 ulcers on the lateral aspect of his forefoot, a passively correctible equinocavovarus foot, and continuous posterior tibial tendon activity on EMG. What is the best next step in management?
Posterior tibial tendon transfer to the lateral cuneiform
Peroneal brevis and tendoachilles lengthening
Split posterior tibial tendon transfer
Calcaneus slide osteotomy