Aims

Single event multilevel surgery (SEMLS) has been shown to improve gait in children with cerebral palsy (CP). However, there is limited evidence regarding long-term outcomes and factors influencing them.

Although equinus gait is the most common abnormality in children with spastic cerebral palsy (CP) there is no consistency in recommendations for treatment, and evidence for best practice is lacking. The Baumann procedure allows selective fractional lengthening of the gastrocnemii and soleus muscles but the long-term outcome is not known. We followed a group of 18 children (21 limbs) with diplegic CP for ten years using three-dimensional instrumented gait analysis. The kinematic parameters of the ankle joint improved significantly following this procedure and were maintained until the end of follow-up. We observed a normalisation of the timing of the key kinematic and kinetic parameters, and an increase in the maximum generation of power of the ankle. There was a low rate of overcorrection (9.5%, n = 2), and a rate of recurrent equinus similar to that found with other techniques (23.8%, n = 5).

As the procedure does not impair the muscle architecture, and allows for selective correction of the contracted gastrocnemii and soleus, it may be recommended as the preferred method for correction of a mild fixed equinus deformity.

Introduction: Congenital clubfoot is a very common deformity in developing countries which leads to secondary socioeconomic problems. Clubfoot programs using the Ponseti method have been initiated in many third world countries in the last years. However, many treatment related, logistic, and structural problems are encountered during these efforts. We report our two-year experience with a clubfoot program in Mali.

Methods: In April 2006 a clubfoot program was initiated in Bamako, Mali by Doctors for Disabled, an Austrian society for medical development cooperation. Teaching material and documentation forms were created and a first Ponseti course was held in Bamako in October 2006. Further visits for advanced teaching, documentation, follow-up and implementation of a clinical structure were scheduled approximately every three months. Parallel to the Ponseti program a program to operate neglected or resistant clubfeet was initiated. Regular meetings with the government at different levels were attained and efforts were made to include the clubfoot program into the national RBC program.

Results: During workshops in October 2006 and January and March 2007 seven health care workers have been intensively trained in the Ponseti method. A review of our documentation showed that up to now 235 patients had been seen and treated. Out of 105 children with idiopatic clubfoot who presented younger than one year of age 52 were available for follow-up after the end of Ponseti treatment. The outcome was “good” or “medium” in 40 patients (77%) and “poor” in 12 children (23 %). The late age at presentation, the low compliance and the rare use of the abduction orthosis are ongoing problems which could not have been solved yet. Additionally, the structural improvements in our treatment center as well as the direct government support are still insufficient.

Conclusion: Due to the low-tech and low-cost approach the Ponseti method is suitable for the developing world. Nevertheless, many obstacles have to be overcome to implement a sustainable project, most of which are not so much treatment associated but of structural, organizational and political nature.