Foot & Ankle International - July 2018 - 815

815

Putz et al

Figure 2. Algorithm indicating operative intervention for equinus foot deformity using the Silfverskiöld test and 3-dimensional gait
analysis. Plantarflexion > 1 standard deviation above the norm.
Table 2. Number of Operative Procedures in Single-Event
Multilevel Surgery.
Procedure
Gastrocnemius-soleus intramuscular
aponeurotic lengthening
1. Isolated gastrocnemius
2. Gastrocnemius and soleus
Achilles tendon lengthening
Psoas lengthening
Proximal rectus femoris recession
Adductor lengthening
Hamstring lengthening
Posterior capsulotomy
Distal rectus femoris transfer
Soft-tissue procedures foot
Pelvic osteotomy
Femoral derotation osteotomy
Tibial derotation osteotomy
Foot stabilization for valgus deformitya

Number of Legs
(n = 62)
48
30
18
3
4
6
6
11
2
14
6
1
37
7
10

a
Operative procedures included calcaneocuboid-joint distraction fusions,
Chopart, and triple fusion.

dorsiflexion was at least 2 standard deviations above the
reference for at least 50% of stance phase. Persistent equinus was captured if the mean dorsiflexion in stance was at
least 2 standard deviations above the reference for at least
50% of the stance phase. Normal values were obtained from
an age-matched reference group of 25 normal subjects. The

level of significance was set at P = .05 for all statistical
tests. Statistical analysis was performed using IBM SPSS
Statistics for Windows, version 22.0.

Results
Gait indices, including the GGI and the GPS, showed a significant decrease indicating an improvement of the gait
pathology. Clinical examination of ankle dorsiflexion and
ankle plantarflexion improved but did not include any significant changes comparing pre- and postoperative data
(Table 3). The comparison of ROM between operative groups
(Baumann [n = 17], Strayer [n = 32], and Achilles tendon n =
3] lengthening) indicated that although the Achilles tendon (n
= 3) lengthening group was too small, the Baumann and the
Strayer group showed no significant difference: (1) Baumann:
ankle dorsiflexion with knee extended (P = .7), ankle dorsiflexion with knee flexed in 90° (P = .95), and ankle plantarflexion with knee extended (P = .1); (2) Strayer: ankle
dorsiflexion with knee extended (P = .07), ankle dorsiflexion
with knee flexed in 90° (P = .1), and ankle plantarflexion
with knee extended (P = .2). Kinematic data including ROM
in stance (and ROM swing) showed no significant difference
within the Baumann and Strayer group (Baumann: ROM in
stance [P = .2], ROM in swing [P = .09], Strayer: ROM in
stance [P = .09], ROM in swing [P = .09]). Pre- and postoperative ankle dorsiflexion power (MRC Scale18) was almost
identical, but ankle plantarflexion strength decreased significantly after surgery. The tone of the triceps surae measured
by modified Ashworth Scale4 showed a postoperative



Table of Contents for the Digital Edition of Foot & Ankle International - July 2018

Contents
Foot & Ankle International - July 2018 - Intro
Foot & Ankle International - July 2018 - Cover1
Foot & Ankle International - July 2018 - Cover2
Foot & Ankle International - July 2018 - i
Foot & Ankle International - July 2018 - ii
Foot & Ankle International - July 2018 - Contents
Foot & Ankle International - July 2018 - iv
Foot & Ankle International - July 2018 - v
Foot & Ankle International - July 2018 - vi
Foot & Ankle International - July 2018 - vii
Foot & Ankle International - July 2018 - viii
Foot & Ankle International - July 2018 - 1A
Foot & Ankle International - July 2018 - 1B
Foot & Ankle International - July 2018 - ix
Foot & Ankle International - July 2018 - x
Foot & Ankle International - July 2018 - xi
Foot & Ankle International - July 2018 - xii
Foot & Ankle International - July 2018 - 2A
Foot & Ankle International - July 2018 - 2B
Foot & Ankle International - July 2018 - xiii
Foot & Ankle International - July 2018 - xiv
Foot & Ankle International - July 2018 - xv
Foot & Ankle International - July 2018 - xvi
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Foot & Ankle International - July 2018 - xxvi
Foot & Ankle International - July 2018 - 3A
Foot & Ankle International - July 2018 - 3B
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Foot & Ankle International - July 2018 - Cover3
Foot & Ankle International - July 2018 - Cover4
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