Journal of Pediatric Orthopaedics - 2026-07-22 - Journal Article
Calcaneal Lengthening Osteotomy in Cerebral Palsy: Does Age at Intervention Influence Outcomes?
Westberry DE, Bailey JM, Shull ER, Layton BB, Hyer LC
Topics
Key Takeaway
Calcaneal lengthening osteotomy in CP achieves equivalent radiographic correction and revision rates (11.8% vs 7.1%, p>0.05) regardless of whether surgery is performed before or after age 8.
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Summary
This study asked whether age at calcaneal lengthening osteotomy (<8 vs >8 years) influences long-term radiographic maintenance and clinical outcomes in CP patients. Retrospective review of 155 feet with mixed-effects modeling showed both cohorts achieved significant radiographic improvement with no between-group differences at final follow-up. Revision rates were 11.8% (younger) vs 7.1% (older), overcorrection occurred in 2 feet both in the younger cohort, and persistent pain was ~10% in both groups.
Key Limitation
The 8-year age cutoff is arbitrary and not derived from a data-driven threshold analysis, potentially masking a true inflection point at a younger or older age.
Original Abstract
BACKGROUND
The optimal age for calcaneal lengthening osteotomy in children with cerebral palsy remains controversial. Younger age has been suggested as a risk factor for recurrence or overcorrection, but long-term clinical data are limited. The primary purpose of this study was to determine whether age at surgery influences long-term radiographic maintenance of correction and clinical outcomes.
METHODS
A retrospective review was performed of 102 patients (155 feet) with cerebral palsy who underwent lateral column lengthening as part of a foot reconstruction procedure between 1990 and 2020 with a minimum of 5 years of radiographic follow-up. Patients were divided into 2 cohorts based on age at surgery: younger than or equal to 8 years (55 patients, 85 feet) and older than 8 years (47 patients, 70 feet). Radiographic parameters were measured preoperatively and at the latest follow-up. Longitudinal changes were assessed using mixed-effects modeling. Secondary outcomes included revision surgery, persistent pain, and pedobarographic analysis in a subset of patients.
RESULTS
Both cohorts showed significant improvement in nearly all radiographic parameters postoperatively (P<0.05), with no differences between groups at long-term follow-up. Mixed-effects modeling demonstrated gradual changes in several radiographic measures over time; however, rates of change were similar between cohorts. Revision surgery was performed in 11.8% of feet in the younger cohort and 7.1% in the older cohort (P>0.05). Overcorrection requiring revision occurred in 2 feet, both in the younger cohort. Persistent pain was reported in ~10% of patients in both groups. Pedobarographic analysis demonstrated improvement in fore-aft loading and directionally more normalized loading in the medial-lateral distribution in both cohorts, although medial-lateral changes were not statistically significant.
CONCLUSIONS
Foot reconstruction involving calcaneal lengthening osteotomy provides radiographic correction and acceptable clinical outcomes in children with cerebral palsy, regardless of whether surgery is performed before or after 8 years of age. Age at surgery was not associated with increased recurrence, revision, or persistent pain at long-term follow-up.
LEVEL OF EVIDENCE
Level III-retrospective comparative study.