Introducing an Innovative Method to Treat Spastic Cerebral Palsy with Faster Recovery Time: Post-Achilles Tendon Lengthening with Bandaging

Equinus deformity is one of the most common musculoskeletal deformities of Cerebral Palsy (CP) which is defined as an abnormality in ankle dorsiflexion that can cause severe walking disability. The standard surgical intervention for Equinus deformity is Achilles Tendon Lengthening (ATL) with post-operative leg casting, however in some cases, it requires months of recovery post-operation to regain movement. The objective of this study was to find an alternative to leg casting that would provide a safe and faster time course to recovery. Therefore, we conducted a semi-experimental clinical trial study of a population that included 62 CP patients between the ages of 6 - 15 years of age with diplegia, hemiplegia, or quadriplegia that randomly underwent ATL followed by subsequent leg casting (control, 32 patients) or bandage and ankle-foot orthosis (AFO; experimental, 30 patients). Patients were periodically evaluated for mobility and walking ability pre-operation and at 2 weeks post- operation, 6 weeks post-operation, and then every month for 6 months. We found that all 32 patients in the experimental group regained their walking ability within two weeks (100%), while majority of patients in the control group (84%) regained their walking ability after 4 - 6 weeks, regardless of CP type. We also found that on 6-month follow-up, progression of walking abilities was similar in both groups. Rupture of the repaired tendon was not observed in any of the participants in either group. This study suggests applying a bandage with a foot or ankle orthosis as an alternative to long leg cast in children of 15 years of age or younger with CP treated with ATL for Equinus deformity to facilitate faster post-operative recovery. It also recommends follow-up studies on confounding factors, categorization of pre- and post-operative range of movement, and post-op complications with longer follow up while treating CP patient with ATL followed by AFO.