Calcaneal Lengthening Osteotomy in Cerebral Palsy: Does Age at Intervention Influence Outcomes?

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.