L'allongement des triceps suraux par bottes successives

The study evaluates a six-year experience of treatment of the triceps shortening in children with Cerebral Palsy using serial casting. During the considered period, we treated 77 children between 3 and 13 years (62 diparetics and 15 hemiparetics); we treated 135 legs using 239 casts. Most of the children walked in a autonomous way, only 9 ambulated with an assistive device. The quantification of the results was realized by the measure of the passive range of motion of the ankle joint, knee flexed (soleus) and knee extended (gastrocnemius), and by the video evaluation of the gait. The 77 subjects were treated in majority with two casts, one per week; in the third party of the cases a single week of treatment was sufficient. After the removal of plasters we realized a phase of rehabilitation with at least 3 sessions per week during approximately 2 months, and the children used braces to maintain the gain in dorsiflexion of the foot and to improve gait. The mean improvement was 14.8° for the soleus and 14.6° for the gastrocnemius, with much better results for the children who walked in an autonomous way. We did not find any correlation between the age of the child and the obtained gain or the number of necessary casts. Twelve children, 2 hemiparetics and 10 diparetics, were treated with botulinum toxin 2-4 weeks before casting: the combined casting + BT group and the cast-only group showed the same outcome. After 6 months the mean loss of extension was 6.9° for the soleus and 7.4° for the gastrocnemius; this datum presents however a great variability which seems correlated to the correct use of orthosis, to the compliance to the physioterapic regime and to the functional improvement in gait.