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04-OCTOBER-2017 THAMER BIJAD AL-SHAREEF 5 YEARS
RESIDUAL AFTER C.P. LEFT FOOT EQUINUS AND VARUS HEEL.
The patient came to the clinic 29-July-2017
complaining of both feet deformity since birth,
more pronounced in the right foot with pes
equina varus with tendency to fall due to wrong
steppage in the right foot. He is the 4th baby
in the family with no family history for such
condition. He was born prematurely through
Caesarian section and was in incubator for one
month with jaundice. He has delayed milestones,
and squint left eye, wearing glasses. He started
walking at 3 years age with frequent fall due to
On examination, the patient has normal higher
brain functions, with normal upper limbs down to
normal knees, but spastic lower limbs and gross
pes equina varus both feet more the right, with
limited dorsiflexion of the foot and tendency to
fall due to right foot deformity.
The patient was sent for investigations. MRI of
the brain performed 01-August-2017 showing
periventricular ischemic changes, normal MRI of
the whole spine. The patient was operated for
the right side
05-Augusst-2017 and now the left
side will be corrected.
Z-plasty elongation of
the left Achill's tendon. The insertion of the
the left anterior tibialis tendon was exposed in the
left foot. Exposure of the same tendon at the
lower third of the left foreleg. The tendon was
split in 2 parts. (STATT), The lateral part was
transferred to the cuboid of the left foot using
the C-arm and was fixed to the tunnel created in
the cuboid bone with 2 zero Ethicon fixed at the
bottom of the left foot. Routine closure of the
wounds and above knee cast
applied with maximum dorsiflexion of the foot.
Smooth postoperative recovery. The
patient was sent to the ward.
The patient has residual of cerebral
palsy with spastic diplegia with club feet, more the right
causing him falling during walk. Surgical correction of the
deformed foot is the best way to correct this deformity by
elongation the stretched tendons and transferring the
The patient's family were satisfied with
first result and willing to perform the contralateral foot.