Gulzar Saeed Ahmed, Syed Muhammad Ali, Imtiaz Ahmed Tago.
Outcome of Z-Plasty Lengthening of Achilles Tendon for Correction of Equinus Deformity of Foot in Children with Cerebral Palsy.
Ann Pak Inst Med Sci Jan ;9(1):38-40.

Objective: To analyze the outcome of z-plasty lengthening of Achilles tendon for correction of equinus deformity of foot in children with cerebral palsy. Study Design: Observational Study. Place and Duration of the Study: The study was conducted at Liaquat University Hospital and a private practice set up between January 2008 and January 2012. Materials and Methods: Inclusion criteria was ambulant children between 6-10 years of age, with spastic cerebral palsy, with one (hemiplegic ) or both(diplegic) lower limbs involved, and inability to passively dorsiflex the ankle beyond 10 degrees of planter flexion (minus 10 degree of dorsiflexion or 10 degrees of plantar flexion) with knee flexed. Z-Plasty lengthening of Achilles tendon was performed.. Results: A total of 30 patients (44 feet) were included in the study and followed for 2 year. The mean age was 8 years. Sixteen (53.33%) patients were spastic hemiplegic and 14(46.66%) were spastic diplegic. A total of 44 feet were operated. Before surgery the passive range of movement was between 10 degree and 20 degree of plantar flexion in all 44 feet. After the surgery 36 out of 44 feet (81.81%) were pain free plantigrade with passive range of movement between 20 degrees of dorsiflexion and 20 degrees of planter flexion. Six out of 44 feet (13. 63%) had inadequate correction. The passive range of movement in these six feet was between 00 to 20 degrees of planter flexion. One (3.33%) patient who was operated in both feet developed crouch gain. At two years of follow up there was no recurrence in fully corrected 36 feet but the remaining six feet which had inadequate correction after initial surgery showed increase in equinus with passive range of movement between 15 to 20 degrees of planter flexion. Superficial wound infection was seen in 6/44(13.63%) feet. Conclusion: Z-Plasty lengthening of Achilles tendon for correction of equinus deformity of foot in children with cerebral palsy produces good short term results. Significant number of patients have pain free plantigrade foot after surgery. There is no recurrence written in two years. Patients with inadequate correction were worsening of the equinus deformity. Excessive lengthening should be avoided as it leads to crouch gait. Studies are needed to evaluate the long term results of this procedure.

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