SYSTEMATIC REVIEW ON EXTENDED POSTERIOR RELEASES IN EQUINUS FOOT DEFORMITY IN CHILDREN WITH CEREBRAL PALSY

Abstract

Equinus foot deformity is a relatively common gait disorder in children, which is frequently seen in cerebral palsy, idiopathic clubfoot, and syndromic conditions including arthrogryposis. While conservative approaches such as physiotherapy, orthotic management, and functional re-education are effective in flexible cases, surgical intervention is required for rigid or recurrent deformities. Extended posterior release (EPR), which entails the Achilles tendon lengthening, rear capsular release, and subtalar joint release, have been considered a conventional surgical procedure used to treat severe equinus.This review presents a synthesis of EPR role in the treatment of paediatric equinus deformity in terms of outcome, recurrence and complications. Clinical trials have always shown a significant increase in ankle dorsiflexion, gait variables and functional mobility after EPR, especially in children with cerebral palsy and relapsed clubfoot. Nevertheless, the rate of recurrence is high, between 10 and 30% particularly in spastic cerebral palsy. The occurrence of complications, including overcorrection, postoperative stiffness, and impaired wound healing, limits the widespread application of this technique.Compared with other procedures, such as tendon transfers, percutaneous gastrocsoleus lengthening, selective nerve repair, and the Ponseti technique for neglected clubfoot, EPR offers greater safety in correction but is associated with higher morbidity. Recent evidence emphasises the need to use individualized treatment choices, incorporating less invasive and adjunctive interventions where needed.As a result, long-term release has been proven to be an effective instrument in the treatment of severe equinus foot deformity in children. The selection of cases, rehabilitation, and long-term follow-up should be carefully selected to maximize the results. Prospective research on the standardized outcome measurement should be done later to provide clearer guidelines on the treatment