Ki Hyuk Sung, MD
Department of Orthopaedic SurgerySeoul National University
Bundang HospitalTalar morphologic changes after tendo-Achilles
lengthening for long-standing equinus deformity in patients with
residual poliomyelitis
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IntroductionCoronal angular deformity of the lower limb is a
common finding in growing childrenPermanent (irreversible)
hemiepiphysiodesisTemporary (reversible) hemiepiphysiodesis using
staples, percutaneous screws, or a tension band plate
(eight-plate)
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IntroductionMeasuring the rate of correction is necessary to
predict the time to end pointThe rate of angular correction has
been calculated simply by averaging.Other factors (age, surgical
method, direction of deformity, etiology, physis) must be
considered while estimating the rate of correction
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IntroductionA linear mixed model (LMM) is useful in settings
where multiple correlated measurements are made on the same
statistical units LMM consists of fixed effects and random
effectsEstimation of the correction rate by using a mixed model
application may confer more practical information to clinicians
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PurposeTo investigate the talar morphologic changes after TAL
for long-standing equinus deformity in patients with RP To
investigate whether the severity of preoperative equinus deformity
affect occurrence of symptomatic anterior impingement.
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Material and methods
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Inclusion criteria
Consecutive patients with residual poliomyelitis, who underwent
tendo-Achilles lengthening for equinus foot deformity since
2003Patients who had preoperative and postoperative weight bearing
lateral foot-ankle radiographsPatients with a minimum follow-up of
6 months
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Exclusion criteria
Patients with inadequate foot-ankle radiographs for
measurementPatients with history of previous foot surgery Patients
who had concomitant anterior bony spur excision with TAL
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Radiographic measurement
Lateral foot weight bearing radiographTalocalcaneal angle
Plantigrade angle McDermott grade Presence of anterior blocking
spur
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Talocalcaneal angle
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Plantigrade angle
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McDermott gradegrade 1, anterior tibial spur measuring less than
3mmgrade 2, anterior tibial spur measuring more than 3mmgrade 3,
anterior tibial spur with secondary talar spur (kissing
lesion)grade 4, panarthritis
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McDermott grade
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Anterior blocking spur
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Statistical analysisComparison between preoperative and
postoperative McDermott grade Wilcoxon signed ranks test
Comparison of preoperative radiographic measurements between the
patients with and without anterior ankle pain, and between the
patients with and without anterior blocking spurIndependent
t-test
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Results
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Patients demographics and radiographic measurementsGender (M /
F)13 / 14Age at operation (year)43.89.4 (range 21.7 to 63.3)Right/
Left17 / 10Follow-up duration (year)2.92.2 (range 0.6 to 8.4)Foot
deformity E/ EC/ EV/ ECV/ EPV7/ 2/ 2/ 14/ 2Preoperative
talocalcaneal angle ()78.514.2Preoperative plantigrade angle
()99.514.3McDermott grade* Preoperative0 (range, 0 to 4) Latest
follow-up3 (range, 0 to 4) p-value
