Short- to mid-term outcomes of individualized combined surgery for pes planovalgus in ambulatory cerebral palsy

Şükrü Demir; Oğuz Kaya; Mustafa Karakuzu; Muhammed Kazez

Short- to mid-term outcomes of individualized combined surgery for pes planovalgus in ambulatory cerebral palsy

Abstract

Aims: Pes planovalgus (PPV) deformity is a common deformity in ambulatory patients with cerebral palsy (CP), and progressive cases may require surgery. This study aimed to evaluate short- to mid-term radiological and functional outcomes following individualized combined surgical treatment in ambulatory CP patients. Methods: Twenty-five ambulatory patients with CP who underwent surgical treatment for PPV were retrospectively reviewed. Demographic characteristics, surgical procedures, radiological parameters, and American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores were assessed. Preoperative and postoperative values were compared using paired t-tests or Wilcoxon signed-rank tests. Surgical strategy was individualized based on deformity severity, flexibility and associated muscle tendon imbalance. Results: The mean age was 15.16±3.80 years (range, 9-25 years), and the mean follow-up duration was 1.67±0.77 years. The most common surgical approach was achilloplasty combined with midfoot or calcaneal osteotomy (72%). Significant postoperative improvements were observed in calcaneal pitch (p=0.006), Kite angle (p=0.015), lateral talocalcaneal angle (p=0.022), Gissane angle (p=0.039), and Simons angle (p=0.007). The AOFAS Ankle-Hindfoot score significantly improved from 40.88±12.88 to 83.52±8.34 (p<0.001). Other parameters showed trends toward improvement without statistical significance. Conclusion: Individualized combined surgical treatment may provide short- to mid-term radiological correction and functional improvement in ambulatory patients with CP-related PPV. However, longer follow-up studies with CP-specific functional assessments are needed to confirm the durability of correction and recurrence rates.

Keywords

Supporting Institution

The authors declared that this study received no financial support.

Project Number

Not applicable

Ethical Statement

This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Fırat University Non-Interventional Research Ethics Committee (Date: 25.12.2025, Decision No: 2025/19-22). As this was a retrospective study, formal written informed consent was not required and was therefore not obtained.

Thanks

Not applicable.

References

Sees JP, Miller F. Overview of foot deformity management in children with cerebral palsy. J Child Orthop. 2013;7(5):373-377. doi:10.1007/s11832-013-0509-4
Chan G, Miller F. Assessment and treatment of children with cerebral palsy. Orthop Clin North Am. 2014;45(3):313-325. doi:10.1016/j.ocl.2014.03.003
Bloom T, Sabharwal S. Surgical management of foot and ankle deformities in cerebral palsy. Clin Podiatr Med Surg. 2022;39(1):37-55. doi:10.1016/j.cpm.2021.09.001
Pfeiffer M, Kotz R, Ledl T, Hauser G, Sluga M. Prevalence of flat foot in preschool-aged children. Pediatrics. 2006;118(2):634-639. doi:10.1542/peds.2005-2126
Evans AM, Rome K. A Cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet. Eur J Phys Rehabil Med. 2011; 47(1):69-89.
Dogan A, Albayrak M, Akman YE, Zorer G. The results of calcaneal lengthening osteotomy for the treatment of flexible pes planovalgus and evaluation of alignment of the foot. Acta Orthop Traumatol Turc. 2006; 40(5):356-366.
Rodriguez N, Volpe RG. Clinical diagnosis and assessment of the pediatric pes planovalgus deformity. Clin Podiatr Med Surg. 2010;27(1): 43-58. doi:10.1016/j.cpm.2009.08.005
Nester C, Jones RK, Liu A, et al. Foot kinematics during walking measured using bone and surface mounted markers. J Biomech. 2007; 40(15):3412-3423. doi:10.1016/j.jbiomech.2007.05.019

Boulay C, Jacquemier M, Castanier E, et al. Planovalgus foot deformity in cerebral palsy corrected by botulinum toxin injection in the peroneus longus: clinical and radiological evaluations in young children. Ann Phys Rehabil Med. 2015;58(6):316-321. doi:10.1016/j.rehab.2015.09.001
Bok SK, Kim BO, Lim JH, Ahn SY. Effects of custom-made rigid foot orthosis on pes planus in children over 6 years old. Ann Rehabil Med. 2014;38(3):369-375. doi:10.5535/arm.2014.38.3.369
MacInnes P, Lewis TL, Griffin C, Martinuzzi M, Shepherd KL, Kokkinakis M. Surgical management of pes planus in children with cerebral palsy: a systematic review. J Child Orthop. 2022;16(5):333-346. doi:10.1177/18632521221112496
Yoo WJ, Chung CY, Choi IH, Cho TJ, Kim DH. Calcaneal lengthening for the planovalgus foot deformity in children with cerebral palsy. J Pediatr Orthop. 2005;25(6):781-785. doi:10.1097/01.bpo.0000184650.26852.37
Aboelenein AM, Fahmy ML, Elbarbary HM, Mohamed AZ, Galal S. Calcaneal lengthening for the pes planovalgus foot deformity in children with cerebral palsy. J Clin Orthop Trauma. 2020;11(2):245-250. doi:10.1016/j.jcot.2018.07.021
Kadhim M, Holmes L Jr, Church C, Henley J, Miller F. Pes planovalgus deformity surgical correction in ambulatory children with cerebral palsy. J Child Orthop. 2012;6(3):217-227. doi:10.1007/s11832-012-0413-3
Dogan A, Zorer G, Mumcuoglu EI, Akman EY. A comparison of two different techniques in the surgical treatment of flexible pes planovalgus: calcaneal lengthening and extra-articular subtalar arthrodesis. J Pediatr Orthop B. 2009;18(4):167-175. doi:10.1097/BPB.0b013e32832c2f32
Elbarbary HM, Arafa AS, Said ABZ, et al. Clinical and radiological outcomes of subtalar arthroereisis for management of planovalgus foot in children with cerebral palsy: 3-year follow-up. Foot Ankle Spec. 2022; 15(6):536-544. doi:10.1177/1938640020980911
Bilgili F, Demirel M, Koyuncu D. Preliminary results of calcaneal lengthening osteotomy combined with extra-articular subtalar arthrodesis for severe pes planovalgus deformity in children with cerebral palsy: a new surgical technique. J Pediatr Orthop. 2024;44(7): e647-e656. doi:10.1097/BPO.0000000000002698
Zargarbashi RH, Aghajani M, Panjavi B, Baghdadi S. Talonavicular fusion in the treatment of planovalgus foot in ambulatory children with cerebral palsy. J Pediatr Orthop Soc North Am. 2025;13:100255. doi:10.1016/j.jposna.2025.100255
Kadhim M, Holmes L Jr, Miller F. Long-term outcome of planovalgus foot surgical correction in children with cerebral palsy. J Foot Ankle Surg. 2013;52(6):697-703. doi:10.1053/j.jfas.2013.06.010
Nahm NJ, Sohrweide SS, Wervey RA, Schwartz MH, Novacheck TF. Surgical treatment of pes planovalgus in ambulatory children with cerebral palsy: static and dynamic changes as characterized by multi-segment foot modeling, physical examination and radiographs. Gait Posture. 2020;76:168-174. doi:10.1016/j.gaitpost.2019.12.004
Abu-Faraj ZO, Harris GF, Smith PA. Surgical rehabilitation of the planovalgus foot in cerebral palsy. IEEE Trans Neural Syst Rehabil Eng. 2001;9(2):202-214. doi:10.1109/7333.928580
El-Hilaly R, El-Sherbini MH, Abd-Ella MM, Omran AA. Radiological outcome of calcaneo-cuboid-cuneiform osteotomies for planovalgus feet in cerebral palsy children: relationship with pedobarography. Foot Ankle Surg. 2019;25(4):462-468. doi:10.1016/j.fas.2018.02.019
Mosca VS. Flexible flatfoot in children and adolescents. J Child Orthop. 2010;4(2):107-121. doi:10.1007/s11832-010-0239-9
Evans AM. Pediatric flat feet: a 2020 guide for clinicians to identify the boomerangs. J Am Podiatr Med Assoc. 2022;112(3):20-103. doi:10.7547/20-103
Xu Y, Zhu Y, Cao YX, Chen G, Xu XY. Does the sagittal radiographic morphology of subtalar joint affect the alignment of foot? Orthop Surg. 2024;16(6):1269-1276. doi:10.1111/os.14054
Church C, Lennon N, Lennon M, et al. Changes in foot posture evaluated with dynamic pedobarography over the course of childhood in ambulatory youth with cerebral palsy. J Child Orthop. 2024;18(1):3-12. doi:10.1177/18632521231208746
Michaudet C, Edenfield KM, Nicolette GW, Carek PJ. Foot and ankle conditions: pes planus. FP Essent. 2018;465:18-23.

Details

Primary Language

English

Subjects

Orthopaedics

Journal Section

Research Article

Authors

Şükrü Demir
0000-0002-1709-3851
Türkiye

Oğuz Kaya ^*
0000-0002-6076-7057
Türkiye

Mustafa Karakuzu
0009-0002-9529-4605
Türkiye

Muhammed Kazez
0000-0002-7344-1064
Türkiye

Publication Date

October 25, 2026

Submission Date

June 18, 2026

Acceptance Date

September 18, 2026

Published in Issue

Year 2026 Volume: 7 Number: 5

IZ

https://izlik.org/JA49NL99HF

Cite

RIS / Bibtex

APA

Demir, Ş., Kaya, O., Karakuzu, M., & Kazez, M. (2026). Short- to mid-term outcomes of individualized combined surgery for pes planovalgus in ambulatory cerebral palsy. Journal of Medicine and Palliative Care, 7(5), 1054-1058. https://izlik.org/JA49NL99HF

AMA

1.Demir Ş, Kaya O, Karakuzu M, Kazez M. Short- to mid-term outcomes of individualized combined surgery for pes planovalgus in ambulatory cerebral palsy. J Med Palliat Care / JOMPAC / jompac. 2026;7(5):1054-1058. https://izlik.org/JA49NL99HF

Chicago

Demir, Şükrü, Oğuz Kaya, Mustafa Karakuzu, and Muhammed Kazez. 2026. “Short- to Mid-Term Outcomes of Individualized Combined Surgery for Pes Planovalgus in Ambulatory Cerebral Palsy”. Journal of Medicine and Palliative Care 7 (5): 1054-58. https://izlik.org/JA49NL99HF.

EndNote

Demir Ş, Kaya O, Karakuzu M, Kazez M (October 1, 2026) Short- to mid-term outcomes of individualized combined surgery for pes planovalgus in ambulatory cerebral palsy. Journal of Medicine and Palliative Care 7 5 1054–1058.

IEEE

[1]Ş. Demir, O. Kaya, M. Karakuzu, and M. Kazez, “Short- to mid-term outcomes of individualized combined surgery for pes planovalgus in ambulatory cerebral palsy”, J Med Palliat Care / JOMPAC / jompac, vol. 7, no. 5, pp. 1054–1058, Oct. 2026, [Online]. Available: https://izlik.org/JA49NL99HF

ISNAD

Demir, Şükrü - Kaya, Oğuz - Karakuzu, Mustafa - Kazez, Muhammed. “Short- to Mid-Term Outcomes of Individualized Combined Surgery for Pes Planovalgus in Ambulatory Cerebral Palsy”. Journal of Medicine and Palliative Care 7/5 (October 1, 2026): 1054-1058. https://izlik.org/JA49NL99HF.

JAMA

1.Demir Ş, Kaya O, Karakuzu M, Kazez M. Short- to mid-term outcomes of individualized combined surgery for pes planovalgus in ambulatory cerebral palsy. J Med Palliat Care / JOMPAC / jompac. 2026;7:1054–1058.

MLA

Demir, Şükrü, et al. “Short- to Mid-Term Outcomes of Individualized Combined Surgery for Pes Planovalgus in Ambulatory Cerebral Palsy”. Journal of Medicine and Palliative Care, vol. 7, no. 5, Oct. 2026, pp. 1054-8, https://izlik.org/JA49NL99HF.

Vancouver

1.Şükrü Demir, Oğuz Kaya, Mustafa Karakuzu, Muhammed Kazez. Short- to mid-term outcomes of individualized combined surgery for pes planovalgus in ambulatory cerebral palsy. J Med Palliat Care / JOMPAC / jompac [Internet]. 2026 Oct. 1;7(5):1054-8. Available from: https://izlik.org/JA49NL99HF