Article

The prevalence of severely symptomatic deformities of the first
metatarsophalangeal (MTP) joint in adolescents with cerebral palsy (CP) requiring
arthrodesis is unknown.
Recent literature regarding these deformities is limited.
We studied the presentation of severe, symptomatic deformities of the first ray
in a large population of children and adolescents with CP and their association
with gross motor function, CP subtype, and other musculoskeletal deformities.
METHOD: We identified 41 patients with CP and a symptomatic deformity of the
first MTP joint, managed by arthrodesis, from a large population based database
over a 21-year period. Information recorded included demographics, CP subtype,
Gross Motor Function Classification System (GMFCS), clinical presentation, and
radiological features. RESULTS: Adolescents with spastic diplegia, at GMFCS
levels II and III, were the most common group to develop symptomatic hallux
valgus. In contrast, non-ambulant adolescents, at GMFCS levels IV and V, with
dystonia or mixed tone, more commonly had dorsal bunions. INTERPRETATION: The
type of first MTP joint deformity in patients with CP may be predicted by the
type and distribution of movement disorder, and by GMFCS level. Specific patterns
of associated musculoskeletal deformities may contribute to the development of
these disorders and may provide a guide to surgical management. WHAT THIS PAPER
ADDS: The prevalence of severe bunions requiring fusion surgery was 2%. The two
types of bunion were hallux valgus and dorsal bunion. The type of bunion can be
identified on both clinical and radiological grounds. The cerebral palsy subtype
is predictive of the type of bunion.
CI - (c) 2018 Mac Keith Press.

Langue : ANGLAIS