Journal of Foot and Ankle Surgery - 2026-08-21 - Journal Article
Hyperselective Neurectomy versus Tendo-Achilles Lengthening for Pediatric Spastic Equinus: A Comparative Cohort Study.
Jerome JTJ, Surendran G, Thirumagal K
Topics
Key Takeaway
In 18 pediatric patients with spastic equinus, reintervention rates were 25% after TAL (2/8) and 20% after HSN (2/10) at approximately 2-year follow-up, with no standardized functional comparison possible between groups.
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Summary
This single-surgeon retrospective study compared sequential treatment-era cohorts of pediatric spastic equinus managed with TAL (2021–2023 early era) versus HSN of tibial motor branches to the gastrocnemius-soleus complex (later era). Reintervention occurred in 2/8 TAL and 2/10 HSN patients; secondary procedures after HSN reflected staged contracture correction rather than failure of spasticity control. No standardized functional outcome measures were collected, precluding quantitative between-group comparison.
Key Limitation
With only 8 and 10 patients per group, sequential rather than concurrent cohorts, no standardized outcome measures, and no blinded assessment, no valid inference about comparative efficacy or safety can be drawn.
Original Abstract
BACKGROUND
Spastic equinus is a common gait-limiting deformity in children with upper motor neuron disorders, particularly cerebral palsy. Surgical management has traditionally emphasized tendon-lengthening procedures such as tendo-Achilles lengthening (TAL), which correct structural shortening but do not address the neural mechanisms underlying spasticity. Hyperselective neurectomy (HSN) of tibial motor branches has emerged as a targeted approach to reduce focal spastic overactivity.
PURPOSE
To describe two sequential treatment-era cohorts managed with TAL or HSN for pediatric spastic equinus and to examine whether the observed clinical and reintervention patterns support further prospective evaluation of mechanism-based surgical selection.
STUDY DESIGN
Retrospective comparative cohort study (Level III).
METHODS
Two sequential treatment eras (2021-2023) from a single surgeon's practice were analyzed. The earlier cohort underwent TAL, whereas the later cohort underwent HSN of tibial motor branches to the gastrocnemius-soleus complex. Treatment selection emphasized clinical differentiation between dynamic and fixed equinus using passive ankle dorsiflexion, clonus assessment, and gait evaluation. Demographic variables, follow-up duration, and need for additional procedures were recorded.
RESULTS
Eight patients underwent TAL and ten underwent HSN. Mean age at surgery was 8.1 and 9.5 years, with mean follow-up of 26 and 23 months, respectively. Additional procedures were performed in 2 of 8 patients after TAL and 2 of 10 patients after HSN. Secondary procedures after HSN reflected staged correction of residual contracture. Clinical records documented qualitative reduction in clonus following HSN, but standardized between-group comparison was not possible.
CONCLUSIONS
These preliminary findings suggest that distinguishing dynamic neural overactivity from fixed contracture may assist surgical selection and sequencing; they do not establish superiority or equivalence between HSN and TAL.