{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T15:18:22Z","timestamp":1780413502998,"version":"3.54.1"},"reference-count":40,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2018,4,2]],"date-time":"2018-04-02T00:00:00Z","timestamp":1522627200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot Ankle Int."],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Equinus foot deformity constitutes a common gait disorder in ambulatory adults with bilateral spastic cerebral palsy (BSCP). The outcome after intramuscular aponeurotic lengthening in the context of single-event multilevel surgery (SEMLS) in adulthood has not been investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We followed a group of 31 ambulatory adults with BSCP and equinus who underwent SEMLS including gastrocnemius-soleus intramuscular aponeurotic recession or Achilles tendon lengthening. All patients were analyzed preoperatively and at least 1 year (mean follow-up period: 1.6 years) postoperatively by clinical examination and 3-dimensional instrumented gait analysis including the Gait Profile Score (GPS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Clinical examination showed no significant improvement of ankle dorsiflexion ( P = .5) and an unchanged plantarflexion ( P = .7) with knee extended but a significant postoperative reduction of spasticity in the calf muscle ( P = .0001) as measured by clinical examination following the modified Ashworth scale. Significant improvement of mean ankle dorsiflexion in stance and swing ( P = .0001) was found. The GPS decreased and improved significantly (15.9 \u00b1 4.6 to 11.4 \u00b1 3.1; P = .0001). Persistence of equinus and calcaneal gait indicating under- and overcorrection at follow-up was found in 1 patient (3%), respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Intramuscular gastrocnemius-soleus aponeurotic recession is part of multilevel surgery corrected equinus deformity in adults. The increase in muscle length led to significant improvement of kinetic and kinematic parameters during walking without a loss of muscle strength and push-off capacity. The risk of overcorrection after equinus correction in adults with BSCP was found to be relatively low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level IV, retrospective case series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1071100718765161","type":"journal-article","created":{"date-parts":[[2018,4,2]],"date-time":"2018-04-02T03:39:54Z","timestamp":1522640394000},"page":"812-820","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Equinus Correction During Multilevel Surgery in Adults With Cerebral Palsy"],"prefix":"10.1177","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6711-7180","authenticated-orcid":false,"given":"Cornelia","family":"Putz","sequence":"first","affiliation":[{"name":"Pediatric Orthopedics and Foot Surgery, Center for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva Maria","family":"Mertens","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Foot Surgery, Center for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian I.","family":"Wolf","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Foot Surgery, Center for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Geisb\u00fcsch","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Foot Surgery, Center for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirjam","family":"Niklasch","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Foot Surgery, Center for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Gantz","sequence":"additional","affiliation":[{"name":"Experimental Orthopedics, Center for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonhard","family":"D\u00f6derlein","sequence":"additional","affiliation":[{"name":"Orthopedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstrasse 18, 83229 Aschau i. Chiemgau, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Dreher","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Foot Surgery, Center for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias C.","family":"Klotz","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Foot Surgery, Center for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,4,2]]},"reference":[{"key":"bibr1-1071100718765161","doi-asserted-by":"publisher","DOI":"10.1016\/j.gaitpost.2009.05.020"},{"issue":"122","key":"bibr2-1071100718765161","first-page":"70","author":"Banks HH.","year":"1977","journal-title":"Clin Orthop Relat 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