The effect of immediate weightbearing after planovalgus foot reconstruction in ambulatory children with cerebral palsy
Background and Objective(s)
Planovalgus (PV) is a common foot deformity in children with cerebral palsy (CP). Orthopedic surgery is widely established as an effective treatment for deformity correction though there is clinical variation in post-op therapy protocols. Immediate weightbearing (WB) after PV foot correction could accelerate recovery but concern for post-op complications causes reluctance. The aim of this study was to determine the prevalence of complications after PV foot surgery in children with early WB vs. non-WB (NWB).
Study Participants & Setting
135 ambulatory children with CP (GMFCS I (12%), II (58%), III (30%)) met inclusion criteria and were included from a children’s hospital setting and assessed in the gait laboratory.
Materials/Methods
This IRB-approved retrospective cohort study included ambulatory children (GMFCS I-III) with CP and PV foot deformity who underwent reconstructive surgery and pre (within 18 months) and post-op (1-3 years) gait analyses. Complications were defined in three 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 1-3 years, by pedobarographic assessment, and (3) long-term, > 3 years, by recurrence requiring surgical revision. Fisher exact tests compared the prevalence of complications between immediate WB and NWB groups. Regression analysis evaluated the relationship between complications and child, surgical, and post-operative factors.
Results
140 surgical events were completed on 224 feet at age 12.7 ± 2.8 years. Following surgery, 84% of children followed an immediate WB protocol, and 16% were NWB for the first six weeks. The prevalence of short-term complications between the WB and NWB groups was no different (nonunion/hardware failure/infection, WB 3%/1%/0%; NWB, 0%/3%/0%; p>0.9). There were no between group differences in mid-term correction status (under- corrected/corrected/over-corrected, 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 post-op; p>0.9). Regression analysis demonstrated WB status was not a significant predictor of correction status or long-term recurrence requiring revision (p>0.05).
Conclusions/Significance
Complication rates were very low after planovalgus foot correction surgery in ambulatory children with CP. There were no significant differences in complications, clinical outcomes, or need for surgical revision between groups who followed immediate WB vs. NWB post-op protocols. Immediate WB after PV foot correction surgery presented no increased risks compared to NWB and should be encouraged in children with CP. Early WB, standing, and walking may prevent disuse muscle weakness and promote faster recovery of gross motor mobility, enhancing patient care. Future studies should examine the impact of early WB on recovery time and long-term functional outcomes.
