Clinical Scorecard: Alterations in Radiographic Angles During Planovalgus Foot Correction in Pediatric Patients with Cerebral Palsy

At a Glance

Key Highlights

• Planovalgus foot is the most common lower limb deformity in children with cerebral palsy, affecting 25–30% of cases.
• Radiographic angular measurements from weight-bearing AP and lateral foot views are essential for diagnosis, treatment planning, and postoperative evaluation.
• Mosca’s calcaneal lengthening technique combined with gastrocnemius lengthening is used for surgical correction, followed by immobilization and rehabilitation.

Guideline-Based Recommendations

Diagnosis

• Use clinical examination to identify structural abnormalities including medial arch collapse and midfoot bulge.
• Obtain weight-bearing foot radiographs to measure key angles: AP Talocalcaneal, AP Talo–1st MT, Talonavicular Coverage, C5M, Moreau–Costa–Bartani, Lateral Talo–1st MT, Lateral Talocalcaneal, and Calcaneal Inclination angles.
• Exclude patients with rigid deformities or forefoot supination requiring medial cuneiform osteotomy.

Management

• Perform Mosca’s calcaneal lengthening osteotomy via lateral approach with possible insertion of tricortical iliac allograft or distraction alone.
• Stabilize osteotomy with Kirschner wires crossing calcaneocuboid joint.
• Address talonavicular uncoverage with reefing if <30% or arthrodesis if >30% or degenerative changes present.
• Perform gastrocnemius lengthening to address triceps surae contracture.
• Postoperative immobilization in below-knee cast for six weeks followed by structured physical therapy and gait retraining.

Monitoring & Follow-up

• Conduct serial radiographic evaluations at preoperative, immediate postoperative, 6 months, 1 year, and 2 years postoperatively.
• Use consistent weight-bearing positioning for radiographs except immediate postoperative films which are non-weight-bearing.
• Assess changes in radiographic angles to monitor deformity correction and surgical outcomes.

Risks

• Potential for subluxation at calcaneocuboid joint if fixation is inadequate.
• Risk of incomplete correction if talonavicular uncoverage is not properly addressed.
• Possibility of residual or recurrent deformity if gastrocnemius contracture is not released.

Patient & Prescribing Data

Pediatric patients with spastic cerebral palsy, GMFCS levels I to V, aged 11–18 years with symptomatic flexible planovalgus deformity

Surgical correction using Mosca’s calcaneal lengthening combined with gastrocnemius lengthening improves foot alignment as evidenced by changes in radiographic angles; postoperative immobilization and rehabilitation are critical for functional recovery.

Clinical Best Practices

• Ensure thorough preoperative clinical and radiographic assessment to confirm flexible planovalgus deformity and exclude rigid or complex cases.
• Standardize radiographic technique and timing to reliably track angular changes over time.
• Tailor surgical approach based on intraoperative findings including degree of talonavicular uncoverage and bone quality.
• Incorporate gastrocnemius lengthening routinely to address associated triceps surae contracture.
• Implement structured postoperative rehabilitation to optimize gait and functional outcomes.

References

• Incidence and characteristics of cerebral palsy
• Planovalgus foot deformity in cerebral palsy
• Mosca’s calcaneal lengthening technique
• Radiographic evaluation of planovalgus foot
• Gross Motor Function Classification System (GMFCS)