Evaluation of foot biomechanics following surgical interventions, including SPOTT and SPLATT procedures in the management of equinovarus deformity in cerebral palsy hemiplegia.

BACKGROUND: Cerebral Palsy (CP) is a group of disorders affecting movement and posture and is the most common physical disability in children. Surgical interventions, such as split anterior and posterior tibial tendon transfers (SPLATT and SPOTT), can be necessary to correct foot and ankle deformities in CP. This is a retrospective pre-/post-operative cohort study that aims to specifically investigate effects on lower limb and foot biomechanics in children with CP.

METHODS: Fifteen children aged 8-16 years at initial assessment (10 girls, 5 boys) underwent SPLATT and SPOTT procedures as part of their CP hemiplegic equinovarus correction. 3D multi-segment foot kinematics, lower limb kinematic and kinetics was assessed pre- and 12months-post operatively using descriptive statistics, one-way ANOVA and statistical parametric mapping.

RESULTS: Walking velocity did not change, but there was a significant reduction in cadence, with a trending, but not significant, increase in stride length. There were several improvements in lower limb kinematics, with significant changes in inversion across all three foot segments. This was accompanied by significant changes in adduction in the mid-foot segment and to a lesser extent, the forefoot segment.

CONCLUSION: Combined equinovarus correction procedures can lead to improvements in foot biomechanics during gait in children with CP hemiplegia. Overall improvements in cadence and the low revision rate further highlight the potential benefits of these procedures. While the individual contribution of each procedure requires further investigation, the outcomes of this study demonstrate the effectiveness of combined surgical procedures and guides clinical decision-making for the treatment of equinovarus deformity in children with cerebral palsy hemiplegia.