Continuous Wear of Night and Day Orthosis Is a Key Factor for Improvement of Fixed Equinus Deformity after the Transverse Vulpius Procedure

• Published in: Children (Basel) 2022-02, Vol.9 (2), p.209
• Main Authors: Wegner, Mathis, Koyro, Katharina I, Kosegarten, Louisa, Hell, Anna Kathrin, Lorenz, Heiko M, Diedrichs, Volker, Lippross, Sebastian
• Format: Article
• Language: English
• Subjects: Ankle; Botulinum toxin; equinus deformity; Gait; gastrocnemius release; gastrocnemius–soleus aponeurotic recession; Orthopedics; Patients; Pediatrics; Physiology; Range of motion; Spasticity; Surgery; Variance analysis
• ISSN: 2227-9067; 2227-9067
• DOI: 10.3390/children9020209

Equinus foot deformity is secondary to either spasticity or contracture of the gastrocnemius-soleus complex. The plantar flexion is basically treated conservatively; several different surgical methods have been discussed. This paper focuses on the improvement of passive ankle dorsiflexion after a transverse Vulpius procedure in equinus foot deformity. Additionally, the influence of consequent postoperative wear of orthosis on the improvement of ankle range of motion was investigated. In total, 41 patients with neuromuscular impairment and 59 equinus feet deformities were surgically treated by using a transverse Vulpius procedure. A total of 19 female patients and 22 male patients with a mean age at surgery of 10.18 years (2 to 31) were included. Mean follow-up took place 12.26 ± 7.95 months after surgery. Passive ankle dorsiflexion was measured and subjective patients' satisfaction was assessed. Range of motion, measured as the maximum of passive ankle joint dorsiflexion, improved significantly from -8° ± 5.9° to 11.1° ± 6.7° directly after surgery to 16.2° ± 10.7° at follow-up. The improvement of passive ankle dorsiflexion was significantly associated with the continuous wearing of night and day orthosis ( = 0.0045). Patient subjective satisfaction was very high. A transverse Vulpius procedure for aponeurotic gastrocnemius and soleus muscle lengthening of equinus foot deformity resulted in a significant improvement of passive ankle dorsiflexion. Positive surgical results correlated to a continuous use of orthotic devices.