Test Deformity Procedure

Silfverskiold test Foot Equinus Positive when there is improved dorsiflexion of the ankle with flexion of the
knee. Negative when there is equivalent ankle dorsiflexion in both knee
flexion and extension.
Confusion test Foot Equinovarus patient is asked to flex the hip against resistance while seated, and the
ankle is inspected. In most children with cerebral palsy the anterior tibialis
fires while the hip is flexed; this is considered a positive confusion test
Popliteal angle Knee Flexion Contracture patient is positioned supine on an examining table and the hip is flexed to 90
degrees. The ipsilateral flexed knee is then extended, and the angle
between the vertical and where the tibia may be extended to is the popliteal
angle
Duncan-Ely test Rectus femoris spasticity positioning the patient prone and then flexing the knee to 90 degrees. If
there is spasticity in the rectus femoris, the ipsilateral buttock will rise from
the table as a result of hip flexion caused by the rectus
Rectus grab Rectus femoris spasticity With the patient supine on the examining table, the knee is rapidly flexed. If
resistance is felt, the rectus is spastic.
Thomas test Hip flexion contracture patient is positioned supine on the examining table. The opposite hip is fully
flexed to flatten the lordosis of the lumbar spine and lock the pelvis against
moving. The angle between the table and the hip in question is then
measured, as the hip will rise up in flexion off the table in the presence of a
contracture
Staheli test upper body of the patient prone on the table, with the hips dangling off the
edge of the table. The angle formed by the horizontal and the thigh, at the
point at which further hip extension causes the pelvis to move, is the hip
flexion contracture
Deformity Procedure

Foot Equinus Gastrocnemius recession Recurrent equinus (15-35%)

Calcaneus deformity (overstretching, unrecognized knee
contracture)
Achilles tendon lengthening

Foot Equinovarus Posterior tibialis tendon

lengthening
Split posterior tibialis tendon Tendon is woven into the PB, navicular
transfer Recurrent varus deformity
Anterior tibialis tendon transfer Prerequisite is anterior tibialis overactivity

Knee Flexion Eggers transfer Recurvatum deformity

Contracture
Hamstring lengthening Medial hamstring lengthening suffices in patients with mild
crouch and moderately increased popliteal angles
Goal is less than 20 degree popliteal angle
Rectus femoris Proximal rectus recession
spasticity

Adductor contracture Adductor release
Adductor transfer
Hip flexion contracture Psoas tendon tenotomy
Wide based gait when combined with obturator neurectomy
Adduction contracture with growth (10-37% need of
reoperation)
Less tolerated by patients; complicated with hip and pelvic
inequality if a clip detaches leading to hip subluxation
Leads to loss of hip power in ambulatory patients
Decreased arc of motion
• Level IV study
• 31 cadavers
• Gravity induced equinus in 10-35%
 Operative Plan

Deformity Procedure
Foot Equinus left Gastrocnemius recession left

Knee Flexion Contracture Hamstring lengthening bilateral

bilateral
Rectus femoris spasticity Proximal rectus recession bilateral
bilateral

Adductor contracture Adductor release bilateral

bilateral
OR technique – Adductor release
 OR technique – proximal rectus
release
An incision was made
starting anterior and
distal to the anterior
superior iliac spine.
The incision is carried
down to the plane
between the sartorius
and tensor fascia
latae retracting the
lateral femoral
cutaneous nerve
medially.
The conjoined tendon of
the RF was then
bluntly dissected free
and transected
OR technique – Hamstring
lengthening
OR technique – Gastrocnemius
recession
 Pearls & Pitfalls
• “some equinus but not any
calcaneovalgus”
• Careful not to do obturator neurectomy
• Avoid overcorrection of the ankle
• Identify and avoid the branches of the
obturator nerve as they sandwich the
adductor brevis
 Postop Care
• 0-3 weeks: long leg cast for 3 weeks
• 3-6 weeks: passive and active ROMs
started, muscle strengthening exercises
are started, remove cast at 6 weeks
• 7-12 weeks: resume independent
ambulation
• Brace worn at night for 12 months