Abstract
Introduction. Operative procedures in the area of triceps surae muscle are indicated for correction of pes equinus deformity in patients with cerebral palsy.
Material: In the years 1999-2002, surgical intervention in the area of triceps surae muscle was indicated 447 times in 236 patients of the Clinic of Orthopedics, 2(nd) Medical Faculty, Charles University and Faculty Hospital Motol. The type of operative procedure was decided by the positivity of Silfverskiold test.
Methods: Surgical procedures include those on the gastrocnemius muscle, common aponeurosis of gastrocnemius and soleus and Achilles tendon. Subsequent post-operative evaluation was clinical at 2 and 6 months after surgery and then every 6 months with assessing the local findings and Silf-verskiold test after surgery according to Strayer, examination of ankle dorsiflexion and assessment of locomotion.
Results. After surgery according to Strayer, partial recurrence of equinus deformity occurred after 6 months in 5 patients (8 feet), which is 2.4 % out of the 333 performed surgeries.
After surgery according to Baker, a more prominent dorsiflexion - 20degrees was noted in 1 patient, which is 4.3 % out of 23 surgeries. In Achilles tendon lengthening, the return of equinus deformity occurred in 5 patients (7 feet), i.e., 7.6 %.
Moderate overstretching of Achilles tendon was noted in 1 child (2 feet) after surgery according to Strayer with closed lengthening of Achilles tendon, i.e., 2.1 %. Eighty-seven percent of patients with spastic diparesis and hemiparesis transferred to a higher support device, in 75 % of patients with spastic quadriparesis, contracture resolution occurred after combined procedures on muscles.
Discussion. Surgeries in the triceps surae area are the basic procedures correcting the equinus deformity of the foot.
The type of operative correction needs to be determined according to the positivity and negativity of Silfverskiold test. By preferably using the classical surgery according to Strayer, overstretching of Achilles tendon and creation of pes calcaneus deformity should be prevented.
Operative procedures on muscles should be performed under the age of 6 years. Lengthening of Achilles tendon should be indicated after good consideration when Silfverskiold test is negative and correction should only go to 5degrees of dorsiflexion.
An isolated procedure is rather rare, muscle balance must always be simultaneously restored in the area of hip and knee joints of the lower extremities. Of importance is the subsequent intensive rehabilitation.