The results of the Grice subtalar extra-articular arthrodesis for pes planovalgus deformity in patients with cerebral palsy

Objectives: We evaluated the results of the Grice subtalar extra-articular arthrodesis for pes planovalgus deformity in patients with cerebral palsy and its effectiveness in pro¬viding hindfoot alignment. Methods: Grice subtalar extra-articular arthrodesis was performed for pes planovalgus deformity in 14 feet of nine patients (5 males, 4 females; mean age 10.3 years; range 6 to 12 years) with cerebral palsy. Six patients were diplegic, two patients were paraplegic, and one patient was hemiple- gic. Four patients had unilateral, five patients had bilateral involvement. A fibular graft taken from the distal third of the fibula above the syndesmosis was used in all the patients without any fixation material. The patients were assessed with the AOFAS (American Orthopaedic Foot and Ankle Society) hindfoot scoring system pre- and postoperatively. The mean follow-up was 30 months (range 6 to 81 months). Results: Compared with the preoperative values, the mean AOFAS hindfoot score increased from 53 (range 41 to 81) to 68.4 (range 51 to 96), the mean talocalcaneal angle decreased from 52.6° (38°-60°) to 30.4°, and from 55.8° to 35.9° in fron-tal and sagittal planes, respectively (p<0.05). The mean ankle valgus angle measured on anteroposterior radiographs re¬mained unchanged (mean 5°). Of five patients who underwent bilateral surgery, three (21.4%) developed donor-site fibular nonunion on one side. One (7.1%) of these patients also had graft nonunion and displacement. Treatment was rated as sat¬isfactory by the parents of seven patients (77.8%; p<0.05). Conclusion: Despite donor-site morbidity, the Grice sub- talar extra-articular arthrodesis is an effective procedure for the correction of hindfoot alignment in patients with pes planovalgus deformity secondary to cerebral palsy.