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KMID : 0371219920140010139
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Medical Bulletin of the Presbyterian Medical Center
1992 Volume.14 No. 1 p.139 ~ p.147
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Surgical Correction of Equinus or Equinovarus Deformities
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최경수
정의섭/양창렬/민창기
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Abstract
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Foot deformities in the patient with cherebral palsy are equinus, equinovalgus, equinovarus, toe flexion and other toe deformities due to inolvement of the intrinsic muscles of the foot.
Lengthening of the Achilles tendon is the accepted standard treatment for of the equinus component of the deformity, but it does not correct the varus angulation of hindfoot.
Mnay authors have postulated that overaction of the tibialis posterior is responsible for the varus deformity and have advocated transposition, rerouting, or lengthening of the tendon.
But Hoffer et al. postulated that the spastic anterior tibial muscle is an important cause of varus deformity of the hindfoot in cerebral palsy. Therefore he reported on a series of patients in whom the anterior tibial tendon was split at its
insertion
and half of it was laterally transferred to the cuboid with good results.
From January 1983 to December 1989 forty feet(24 patients) with spastic equinovarus deformities have been treated by authors with HCL* alone (20 feet), HCL with TAST*(15 feet), HCL with TPST*(2 feet), and HCL with TPL*(3 feet).
There were 90% excellent or good and 10% poor result according to Kling's assessment scheme. The late deformities after operation included one calcaneus one valgus, and one varus defomity.
* HCL: Heel cord lengthening.
* TAST: Tibialis anterior split transfer.
* TPST: Tibialis posterior split transfer.
* TPL: Tibialis posterior lengthening.
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KEYWORD
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