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MEDICINA E CHIRURGIA DELLA CAVIGLIA E DEL PIEDE
A Journal on Physiopathology and Surgery of the Foot
Indexed/Abstracted in: EMBASE, Scopus
Chirurgia Del Piede 2002 September;26(3):129-38
Distal Achilles tenoreisis in the treatment of equinus deformity in infantile cerebral palsy
Parino E., Germano M.
Background. One of the commonest sequelae to infantile paralysis is spastic equinus deformity. The deformity, a cause of instability and pain, is the result of hypertonus of the triceps surae. Various treatment methods have been proposed; one alternative to the widespread method of surgical Achilles tendo lengthening is the procedure proposed by JC Scholder in 1949 termed ³freinage achiléen² or Achilles tenoreisis. This surgical technique reduces the clubbing action of the triceps muscle. One half of the tendon is anchored to the tibia; this reisis limits plantar flexion of the foot, thus partly eliminating the effects of muscle contracture causing equinus, while maintaining its modulating action during dorsiflexion.
Methods. In this study the authors present 13 cases of non structured spastic equinus deformity treated by distal tenoreisis of the Achilles tendon at the Center for Foot Surgery «Prof. G. Pisani» from 1991 to 1999. The mean follow-up period was 4 years, 9 months. The mean age of the study group was 12 years.
Results. The results were evaluated clinically or by diagnostic imaging and written questionnaires. In all patients except one complete correction of the equinus deformity without recurrence was achieved. No cases of talus hypercorrection were observed.
Conclusions. Based on an analysis of the results, we can state that the Scholder procedure offers a valuable alternative to Achilles tendo lengthening in the treatment of equinus deformity in infantile cerebral palsy. Moreover, the technique does not structurally alter the Achilles tendon, thus permitting easy reintervention in case of recurrence. Seven adults with spastic equinus deformity unrelated to infantile cerebral palsy were also treated during the same period. The results of this second patient group are also discussed.