Evaluating Radiologic Outcomes of Surgical Techniques Used in Foot Valgus Deformity of Cerebral Palsy Patients: A Systematic Review and Meta-Analysis Publisher Pubmed



Menbari Oskouie I ; Metanat S ; Rahimdoost N ; Kasaeian A ; Pourghazi F ; Eslami M ; Arvin A ; Nabian MH ; Presedo A
Source: BMC Musculoskeletal Disorders Published:2026

Abstract

Background: Planovalgus is the most common deformity in children with cerebral palsy (CP). Numerous surgical interventions like Lateral Calcaneal Lengthening (LCL), Extra-articular Arthrodesis (EAA), Subtalar Arthroereisis (SA), Intra-articular Arthrodesis (IAA), and Talonavicular Arthrodesis (TNA) are available to address it. However, there is currently a lack of evidence defining the optimal surgical approach. This systematic review and meta-analysis aim to evaluate the radiological outcomes of these surgical techniques. Method: Databases were searched to identify relevant studies using keywords related to planovalgus, cerebral palsy, and surgical interventions. After removing duplicates, screening by title and abstract was followed by full-text screening. Data from the included studies were then extracted. Finally, a meta-analysis was performed on the finalized data. Results: The findings revealed that the LCL procedure resulted in significant increases in the calcaneal pitch and the Anterior Posterior talonavicular coverage angle (AP TNCA), while reducing the Lateral talocalcaneal angle (Lat TC), Anterior Posterior talus-first metatarsal angle (AP TM1), and lateral talus-first metatarsal angle (Lat TM1). Similarly, the EAA surgery also enhanced calcaneal pitch and reduced Lat TC, Anterior Posterior talocalcaneal angle (AP TC), AP TM1, and Lat TM1. The SA surgery improved calcaneal pitch but decreased AP TC, and both Lat TC and Lat TM1 were reduced after the IAA intervention, with a significant decrease in AP TC after TNA surgery. Between-technique comparisons were most consistent for lateral talocalcaneal (Lat TC) improvement favoring EAA over LCL, whereas comparisons involving SA and TNA remained underpowered. We therefore grade the comparative evidence as moderate for EAA vs LCL on Lat TC and Lat TM1, and low-to-very low for SA/TNA-related contrasts due to few studies and high heterogeneity. Conclusion: The study concludes that while different surgical approaches have specific advantages, no single technique is definitively the best. The majority of surgeries were conducted on children aged 11–12. More research is necessary to enhance the reliability and accuracy of these findings, guiding better clinical decision-making for treating planovalgus in CP patients. © The Author(s) 2025.