Planovalgus Foot Deformity in Cerebral Palsy

Planovalgus deformity is the most common foot deformity in all ages of children with bilateral pattern cerebral palsy (CP). It is also common in young children with hemiplegic or unilateral CP but has higher tendency to resolve and even overcorrect into equinovarus as the child gets to middle childhood. Although planovalgus is commonly recognized, neither the natural history of the evolution of the deformity nor a detailed description of the pathologic anatomy of the deformity is well defined in the published literature. Although most children with CP develop a clearly recognized planovalgus foot with loss of the medial arch, hindfoot valgus, and foot abduction, there are no recognized objective severity grading systems. Measurements of severity most commonly used are radiographs and pedobarographs, although there is beginning interest in using multi-segment foot kinematics and kinetics. A large part of the understanding and treatment algorithms related to kind of planovalgus collapse deformity in children with CP is still derived from the experience of treating feet with poliomyelitis often utilizing triple arthrodesis. The current treatment algorithm for planovalgus deformity has to consider the child’s age and motor function. The planovalgus deformity will most likely improve into the middle childhood and then slowly regress and may become more severe during adolescent growth. Treatment of young children should focus on orthotic management. Surgical correction of planovalgus feet in children with CP under age 7 or 8 years of age is almost never indicated. There are many associated deformities such as external tibial torsion, hallux valgus, dorsal bunion, and equinus contracture, which also need to be considered when planning surgical correction. Surgical treatment options for planovalgus include calcaneal lengthening osteotomy, limited fusions, and for very severe deformities multiple extensive fusions.