Journal of Pediatric Orthopaedics - 2026-07-22 - Journal Article
Selective Talonavicular Arthrodesis With Talocalcaneal Stabilization for Flexible Planovalgus in Cerebral Palsy: Outcomes Within a Pathophysiology-Based Treatment Strategy.
Badina A, de Remaurin XDC, Goudjo E, Georges S, Kerkouche A, Wicart P, Desailly E, Khouri N
Topics
Key Takeaway
Talonavicular arthrodesis with talocalcaneal stabilization achieved 0% nonunion rate and 83% family satisfaction at mean 4.5 years in ambulatory CP patients with tibialis posterior strength ≤3/5.
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Summary
This study evaluated TNA-TCS for flexible planovalgus in ambulatory CP patients (GMFCS I-IV) with tibialis posterior strength ≤3/5, using a pathophysiology-based surgical algorithm. Walking distance improved significantly (p<0.001) and FMS at 500 meters improved (p=0.01); short-distance mobility was preserved. Unsatisfactory Yoo score (≤8) occurred in 12% of feet, no talonavicular nonunions were observed, and 83% of families reported satisfaction.
Key Limitation
Concomitant SEMLS in a subset of patients prevents isolation of TNA-TCS contribution to functional improvement, making it impossible to determine how much of the walking distance gain is attributable to the foot procedure versus multilevel soft tissue surgery.
Original Abstract
BACKGROUND
Flexible planovalgus deformity in cerebral palsy (CP) is influenced by both structural alignment and dynamic muscle imbalance, affecting medial column stability. When tibialis posterior (TP) strength is markedly impaired, reconstructive osteotomies may fail to provide durable correction. This study evaluates the outcomes of selective talonavicular arthrodesis with systematic talocalcaneal stabilization (TNA-TCS) performed within a pathophysiology-based decision-making algorithm.
METHODS
All consecutive TNA-TCS procedures performed for flexible neurological planovalgus in ambulatory children with CP (GMFCS I to IV) were retrospectively reviewed. Surgical indication was based on deformity flexibility and TP strength (≤3/5 or unreliable assessment). Functional outcomes included the Functional Mobility Scale (FMS), Hoffer classification, walking distance, and pain and shoe-wear difficulties. Clinical outcomes were assessed using the Yoo score and patient satisfaction. Radiographic evaluation included standard angular parameters and sagittal "break" analysis. Complications and union rates were recorded. The mean follow-up was 4.5±1.6 years.
RESULTS
Forty-nine feet in 30 patients (mean age 12.8±2.6 y) were included. Walking distance improved significantly (P<0.001), with FMS improvement at 500 meters (P=0.01), while short-distance mobility remained stable. Functional gains were primarily observed in patients undergoing concomitant single-event multilevel surgery, whereas isolated TNA-TCS preserved ambulatory status. Pain and shoe-wear difficulties markedly decreased. Unsatisfactory clinical outcome (Yoo ≤8) occurred in 12% of feet. Overall satisfaction was high, with 83% of families reporting satisfaction or very satisfied. No talonavicular nonunion was observed. Hardware irritation requiring removal occurred in 2 patients.
CONCLUSIONS
Selective TNA-TCS was associated with satisfactory medial column stabilization and reliable fusion and functional preservation in ambulatory children with CP and TP weakness. In a flexible neuromuscular planovalgus with inadequate dynamic inversion strength, talonavicular arthrodesis with talocalcaneal stabilization represents a rational primary strategy within a pathophysiology-based algorithm.
LEVEL OF EVIDENCE
Level IV.