The management of spastic equinus in cerebral palsy

Equinus of the foot is the most common deformity in children with spastic cerebral palsy. Patients with cerebral palsy who are able to walk may have different problems because of an equinus deformity. They may have a clumsy gait and often stumble, fall and suffer injuries. Secondary hip and knee deformities, forefoot callosities and pain, shoe fitting problems and excessive wear on shoes are common. The treatment of equinus is either nonoperative or operative. Nonoperative treatment is indicated in dynamic equinus, during the fast-growth phase of a child's development. The most favourable results can be expected with a combination of different forms of such treatment including repeated injections of Botulinum toxin type A together with orthotics and physical therapy. If there are simultaneous contractures in the hip and/or knee joints, multilevel surgery with nonoperative treatment of dynamic equinus may be the best solution. Operative treatment is indicated in patients with fixed equinus. In diplegia and quadriplegia the most favourable outcome can be expected with either a procedure on the gastrocnemius muscle or triceps surae muscle. In hemiplegia the best results may be expected with procedures on the triceps surae muscle. Multilevel surgery at the hip and knee joints is the rule in cases of contractures or deformity.