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Lower limb surgery for gait

Recent changes in this area have included a move to one-stage multi-level surgery, with all deformities being dealt with at one sitting, generally at the age of 8 to 10 years. Improvements in anaesthetics, the development of new procedures, and more bony surgery have also helped.

One of the most important improvements is greater use of gait analysis. This has increased the consideration of biomechanical evaluation before and after surgery. Outcomes now tend to focus on gait analysis at one to two years. There is no prospective evidence to show that gait analysis improves surgical outcomes, but it may offer a useful audit tool to be used before and after intervention.

Procedures for lower limb surgery include:

  • lengthening of the psoas, hamstring, achilles tendon, os calcis, gastrocnemius and tibialis posterior
  • split tibialis posterior and anterior transfer
  • rectus femoris transfer, Jones transfer
  • subtalar arthrodesis

There has generally been good clinical feedback on lower limb procedures, with patients responding well although this has been difficult to quantify. There has also been positive feedback from carers and therapists.

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