Benefit most from Treatment
Problems
1. Tight psoas / Adductors / Hamstrings / T Achilles
2. Increased Femoral Anteversion
3. External Tibial Torsion
4. Valgus Foot
Principles
Surgery once walking but before school (3-4)
SEML surgery
Gait analysis lab
Gait
True equinus
Apparent equinus (FFD knee and hip)
Jump
Crouch
Hip
A. FFD
Contracture of iliopsoas is cause
- preserve iliacus to maintain strength of hip flexors
- lengthen psoas at pelvic brim / Sutherland release not divide at LT
- Sutherland release at brim
B. Adduction Contracture
C. Internal Rotation Deformity
Causes intoeing / scissoring gait
- cause unclear
- children with tight hamstring can only sit in W position
- ? causes femoral anteversion
Early release of hamstring can decrease intoeing
DRVO proximal femur
Knee
A. FFD
- due to hamstring contracture
- often unrecognised co-contracture of quads / rectus femoris
- if hamstrings alone lengthened, stiff flexed knee gait becomes stiff extended knee gait
B. Spastic Crouch Correction
- gait with flexed knees & hips
- release psoas / hamstrings / rectus
Ankle & Foot
A. Ankle Equinus
True equinus
- tight T Achilles
Apparent equinus
- tight hamstrings
- patients use equinus to extend knee
- if release T achilles in this situation will cause crouch gait
B. Ankle Equinovalgus
3 Solutions
- Evans Procedure / Lateral Column Lengthening
- STJ fusion & T Achilles lengthening
- Triple Arthrodesis