[Extra-articular arthroereisis according to Grice/Green versus calcaneal lengthening according to Evans: retrospective comparison for therapy of neurogenic pes planovalgus].

BACKGROUND

Common reasons for juvenile neurogenic pes planovalgus are hypoxic brain damage, birth defects of the spinal canal, trauma and cerebral cancer. When symptoms persist despite conservative treatment of symptomatic pes planovalgus, surgery is indicated. Objectives of the operation are improved gait and mobilization as well as an improved basis for wearing shoes. Joint preserving and ankylosing procedures as well as combinations of both are available. The aim of this study was a retrospective comparison of the Grice/Green extra-articular arthroreisis versus the Evans calcaneal lengthening operation.

MATERIAL AND METHODS

Between October 2001 and October 2009 a total of 75 arthroereisis operations were performed according to Grice/Green and in the period from April 2006 to February 2010 a total of 83 calcaneal lengthening operations according to Evans. The focus of the study was on patients with an underlying neurogenic disease which resulted in 72 cases in the Grice/Green group and 70 cases in the Evans group. The average age was 14.6 ± 5.0 years in the Evans group and 10.1 ± 3.4 years in the Grice/Green group. Of the patients in the Grice/Green group 17 had infantile cerebral palsy (ICP) and 25 had other neuromuscular diseases and in the Evans group 14 patients had ICP and 28 patients had other neuromuscular diseases. The medical records, preoperative and postoperative radiographs were analyzed. In addition information was obtained on the quality of life (EQ-5D), mobility and the supply of mobility aids using a specially designed questionnaire. The radiological evaluation was based on preoperative and postoperative lateral and dorso-plantar radiographs. The follow-up time for the questionnaire was on average 54 months (range 12-109 months) for the Grice/Green group and 22 months (range 9-53 months) for the Evans group. The postoperative treatment was similar in both groups.

RESULTS

The talometatarsal (TMT) index could be improved by surgery according to Grice/Green from - 50.2° to - 28.1° and in the Evans group a correction from - 49.6° to - 31.8° was possible. Considering the cases with severe preoperative deformities (TMT index < -50°) there was a significantly greater correction of the lateral talocalcaneal (TC) angle by the method of Grice/Green. In 67 % of patients in the Grice/Green group and 57 % in the Evans group a significant improvement in terms of pain was possible. A significant improvement in gait and possible walking distance was found in 33 % of the Grice/Green group and 43 % of the Evans group and an average improvement was possible in 40 % and 43 %, respectively. The operation was considered to be very successful by 67 % of patients in the Grice/Green group and in 57 % of patients in the Evans group but the difference was not significant. In the Grice/Green group no revisions were necessary and revision was performed in two cases after surgery in the Evans group due to wound infections.

CONCLUSIONS

Both of the processes investigated in this study are suitable for treatment of pes planovalgus. In cases of neurogenic pes planovalgus and also in extreme cases (TMT index < -50°) the procedure according to Grice/Green has radiological advantages for reconstruction of the lateral TC angle.