The Effect of Immediate Weight Bearing After Planovalgus Foot Reconstruction in Ambulatory Children With Cerebral Palsy

BACKGROUND: Planovalgus is a common foot deformity in children with cerebral palsy (CP). Orthopaedic surgery is widely established as an effective treatment for planovalgus deformity, but postoperative protocols vary without a clear rationale. Immediate weight bearing (WB) after planovalgus foot correction may accelerate recovery; however, concerns about complications cause reluctance. This study aimed to determine the prevalence of complications after planovalgus correction in children with CP with early WB versus non-WB (NWB).

METHODS: This retrospective cohort study included ambulatory children (Gross Motor Function Classification System I to III) with CP and planovalgus foot deformity who underwent reconstructive surgery and pre- and postoperative gait analyses. Complications were defined in 3 timeframes: (1) short-term, within 6 months of surgery, by radiograph review for nonunion, hardware failure, or infection requiring return to surgery; (2) mid-term, at 1 to 3 years, by pedobarographic assessment; and (3) long-term, >3 years, by recurrence requiring surgical revision. Fisher's exact tests compared the prevalence of complications between the immediate WB and NWB groups. Regression analysis was used to evaluate the relationship between complications and child, surgical, and postoperative factors.

RESULTS: One hundred thirty-five children with CP (Gross Motor Function Classification System I-12%, II-58%, III-30%) underwent 140 surgical events (224 feet) at age 12.7±2.8 years. Following surgery, 84% of children followed an immediate WB protocol; 16% were NWB for 6 weeks. The prevalence of short-term complications between the WB and NWB groups was not different (nonunion/hardware failure/infection: WB, 3%/1%/0%; NWB, 0%/3%/0%; P>0.9). No differences existed between groups in midterm correction status (undercorrected/corrected/overcorrected: WB, 31%/45%/24%; NWB, 32%/54%/14%; P>0.9). The prevalence of long-term recurrence necessitating surgery was not significantly different (WB/NWB, 3%/11%; 8.5±2.8 years postoperatively; P>0.9). WB status was not a significant predictor of correction status or long-term recurrence requiring revision (P≥0.11).

CONCLUSIONS: There were no significant differences in complications between groups who followed immediate WB versus NWB postoperative protocols. Immediate WB after planovalgus foot correction surgery should be encouraged in children with CP, as early WB may prevent disuse muscle weakness and promote recovery.

LEVEL OF EVIDENCE: Level III-retrospective cohort study.