Long-term Outcomes of Talonavicular Arthrodesis for the Treatment of Planovalgus Foot in Children With Cerebral Palsy

SLR - June 2022 - Anna Kakizaki PGY 2

Reference: Ramírez-Barragán, Galán-Olleros, M., Maroto, R., Egea-Gámez, R. M., & Martínez-Caballero, I. (2022). Long-term Outcomes of Talonavicular Arthrodesis for the Treatment of Planovalgus Foot in Children With Cerebral Palsy. Journal of Pediatric Orthopaedics, 42(4), e377–e383. https://doi.org/10.1097/BPO.000000000000208

Level of Evidence: Level III—retrospective comparative study.

Scientific Literature Review

Reviewed By:
Anna Kakizaki PGY 2
Residency Program: Cambridge Health Alliance, Cambridge, MA 

Podiatric Relevance: As podiatric physicians we commonly treat children with planovalgus foot type. Pediatric patients with cerebral palsy are also not an uncommon encounter. Surgical intervention is debated in this population. In patients with high Gross Motor Function Classification System levels, joint salvage procedures have a high rate of undercorrection and recurrence. Arthrodesis is also an option, and in this article authors focus on isolated talonavicular arthrodesis. It is important for podiatric surgeons to understand long term outcomes of surgical procedures on this particular population. 

Methods: Retrospective study of pediatric patients with cerebral palsy who underwent talonavicular arthrodesis of pes planovalgus between 1999 and 2010. Indications procedure included foot pain, ulceration, unable to tolerate orthotics, and progression of deformity interfering with ambulation. Patients who underwent other surgical pedal procedures other than talonavicular arthrodesis were excluded. All had a minimum follow up of 10 years. Radiographic measurements of surgical correction, functional impact (FFI) at the 10 year follow up, and complications were recorded and correlation was assessed. 

Results: Forty-nine (49) feet from 25 cerebral palsy patients were included in the study. Statistical significance was found between the FFI and angles between the talus and first metatarsal. Four feet (8 percent) developed pain to screw protrusion requiring hardware removal. Seven feet (14.2 percent) developed pseudoarthrosis, and 3 feet out of the seven required triple arthrodesis. Prior to surgery, all patients were unable to tolerate ankle foot orthosis, however at the 10 year follow up all patients were able to use the orthosis without pain. No osteoarthritis was observed in the tibiotalar joint or pedal joint at the 10 year follow up. 

Conclusions: Commonly in pediatric patients with pes planovalgus deformities, we do avoid joint destructing procedures as they do have a concern for secondary arthritis. However there is a high rate of recurrence of deformity in cerebral palsy patients. Moreover, patients with pes planovalgus foot type with cerebral palsy commonly progress to a rigid deformity early in adulthood. There are limitations to this study as it is a retrospective study with a smaller population size. However, from this article we can conclude that talonavicular arthrodesis may be an acceptable treatment in pediatric patients with a high Gross Motor Function Classification System levels.