PURPOSE OF THE STUDY: Surgical procedures on muscles in cerebral palsy are regarded as essential interventions. The tactics for surgery on the triceps surae muscle in the treatment of spastic pes equinus involve several surgical options at different muscle levels. MATERIAL AND METHODS: In the 1992-2008 period, Baker's procedure, prolongation of the triceps muscle in the common part of the gastrocnemius and soleus aponeuroses, was indicated in 114 children, aged between 3 and 18 years, mostly with spastic hemipleia (45.7 %) or diplegia (42.9 %). In both groups, the isolated Baker's procedures and the combined procedures were clinically assessment at 2 and 6 months after surgery. RESULTS: Clinical examination at a follow-up of 8 weeks showed that all patients achieved 5 to 10 degrees of dorsiflexion of the foot. A maximum of Achilles tendon stretch-out was achieved in seven patients (6.14%) after 6 months. In one patient (0.9%) an excessive dorsiflexion was recorded. DISCUSSION: The choice of surgical tactics for treatment of spastic pes equinus is related to a positive or a negative result of the Silfverskiold test, because this shows the degree of contracture of the gastrocnemius and soleus muscles. Prolongation at their joint aponeurosis should be indicated when the test shows partly positive results, and muscle balance at all levels of the lower extremity should be maintained. CONCLUSIONS: Baker's procedure is one of the options to treat spastic pes equinus. The surgery is indicated primarily in isolated pes equinus and in children with spastic hemiplegia with low risk of Achilles tendon excessive elongation. Key words: pes equinus, Silfverskiold test, Baker's procedure.

Ortopedická klinika 2 LF UK a FN v Motole Dětská a dospělá ortopedie a traumatologie

Baker's procedure in the treatment of pes equinus in cerebral palsy patients

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