The treatment of fixed contracture of the gastrosoleus in cerebral palsy using the Baumann procedure: preliminary results of a prospective study

Background Equinus deformity is commonly encountered in children with spastic cerebral palsy. The aim of this work was to assess the results of the Baumann procedure in the treatment of fixed contracture of the gastrosoleus muscle in children with spastic cerebral palsy. Methods In a prospective study, 20 limbs in 15 ambulant children with fixed equinus were treated using the Baumann procedure. The mean age at surgery was 9 years (range, 6 to 16 years). There were 15 limbs (75%) in 10 diplegic patients and five limbs (25%) in five hemiplegics. Physical examination included assessment of active and passive deficits in range of ankle dorsiflexion, the power of ankle plantarflexion using the Medical Research Council grading system and the presence of deformities in other lower limb joints. Gait video recording was carried out preoperatively and postoperatively. The mean degree of preoperative equinus deformity was 53° (range, 30–75°). All involved limbs showed a negative Silfverskiöld test. Preoperatively, 11 patients walked unsupported and four mobilized with support. Seven limbs (35%) required simultaneous hamstring lengthening. Eleven limbs (55%) had a mild hip flexion deformity (10–15°), which had no operative correction. Results The average follow-up was 11.3 months. Satisfactory results were obtained in 16 limbs (80%), while an unsatisfactory outcome was seen in four limbs (20%), namely, recurrence in two limbs (10%), under correction in one and dynamic equinus gait in one. Conclusions The Baumann procedure is effective for the treatment of fixed equinus in diplegic and hemiplegic spastic cerebral palsy. Simultaneous hamstring lengthening, smaller degrees of hip flexion deformity and unsupported ambulation preoperatively had a positive effect on the final result.