Abstract
Grice-Green extra-articular subtalar arthrodesis is a treatment option for advanced
valgus rearfoot deformity of neuromuscular origin in young patients. The purpose of
this study was to evaluate long-term results of the procedure in ambulatory cerebral
palsy patients. From January 1975 to December 1993, 57 operations were performed in
39 patients (22 males, 17 females) with a mean age of 7.8 ± 2.7 (range 3.9–14.4) years
for excessive symptomatic hindfoot valgus. Thirty-five patients (51 feet) were followed
for a mean 22.6 ± 4.6 (range 16.0–32.3) years. Preoperative GMFCS score, ambulation,
hindfoot position, podoscopic view of the weight-bearing feet, and radiological examinations,
along with complications and orthotic use, were compared. Based on a clinical rating
scale, 39 results were excellent or good, 8 were fair, and 4 were poor. The poor results
were attributed to hindfoot valgus recurrence or varus overcorrection. One case needed
revisional surgery owing to slippage of the graft. Overall, the GMFCS score, level
of ambulatory distance, and use of foot orthoses improved. Grice-Green subtalar arthrodesis
did not result in early degenerative changes at the midterm follow-up. The procedure
offers safe and long-lasting correction for severe and symptomatic hindfoot disorders
in patients with cerebral palsy. Together with physiotherapy and orthotic use, it
can improve ambulation. Whereas a slight hindfoot valgus in patients with cerebral
palsy is tolerable without lack of function, overcorrection should be avoided.
Level of Clinical Evidence
Keywords
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References
- An extra-articular arthrodesis of the subastragalar joint for correction of paralytic flat feet in children.J Bone Joint Surg Am. 1952; 34: 927-940
- The role of subtalar fusion in the treatment of valgus deformities of the feet.Instr Course Lect AAOS. 1959; 16: 127-150
- Further experience with extra-articular arthrodesis of the subtalar joint.J Bone Joint Surg Am. 1955; 37: 246-259
- Surgical management of the flatfoot.Instr Course Lect. 1988; 37: 111-115
- Foot Alignment in the cerebral palsy patient.J Bone Joint Surg Am. 1964; 46: 1-15
- Early surgical correction of the planovalgus foot in cerebral palsy. Extra-articular arthrodesis of the subtalar joint.Clin Orthop Relat Res. 1968; 61: 223-233
- Extra-articular arthrodesis of the subtalar joint (Grice procedure): results in seventeen patients with cerebral palsy.JAMA. 1958; 168: 1005-1008
- Extra-articular subtalar arthrodesis. A review of 286 operations.J Bone Joint Surg Br. 1969; 51: 45-52
- The Grice extraarticular subtalar arthrodesis: a clinical review.J Pediatr Orthop. 1985; 5: 442-445
- A simple method of fusion of the subtalar joint in children.J Bone Joint Surg Br. 1968; 50: 369-371
- A modification of the Grice subtalar arthrodesis.J Bone Joint Surg Br. 1968; 50: 372-375
- Subtalar arthrodesis by cancellous grafts and metallic internal fixation.J Bone Joint Surg Br. 1976; 58: 507-510
- Batchelor’s extra-articular subtalar arthrodesis. A report on sixty-four procedures in patients with poliomyelitic deformities.J Bone Joint Surg Am. 1976; 58: 243-247
- Subtalar stabilization of the planovalgus foot by staple arthroereisis in young children who have neuromuscular problems.J Bone Joint Surg Am. 1990; 72: 840-845
- Subtalar extra-articular arthrodesis in the treatment of paralytic valgus deformities. A review of 112 procedures in 100 patients.J Bone Joint Surg Am. 1964; 46: 533-541
- Green-Grice extraarticular subtalar arthrodesis: results using a fibular graft.J Pediatr Orthop. 1987; 7: 29-33
- Subtalar arthrodesis for stabilization of valgus hindfoot in patients with cerebral palsy.J Pediatr Orthop. 1993; 13: 634-641
- Local bone-graft technique for subtalar extraarticular arthrodesis in cerebral palsy.J Pediatr Orthop. 1998; 18: 75-80
- The Grice procedure: indications and evaluation of long-term results.Clin Orthop Relat Res. 1980; : 194-200
- The Grice extra-articular subtalar arthrodesis in the treatment of spastic hindfoot valgus deformity.Dev Med Child Neurol. 1989; 31: 665-669
- Lateral talocalcaneal angle in assessment of subtalar valgus: follow-up of seventy Grice-Green arthrodeses.Foot Ankle. 1983; 4: 56-63
- Grice subtalar arthrodesis followed to skeletal maturity.J Pediatr Orthop. 1988; 8: 176-183
- The Foot and Leg.W.B. Saunders, Philadelphia1972
- Development and reliability of a system to classify gross motor function in children with cerebral palsy.Dev Med Child Neurol. 1997; 39: 214-223
- The Childs Foot.W.B. Saunders, Philadelphia1986
- Degenerative joint disease in female ballet dancers.Am J Sports Med. 1995; 23: 295-300
- The correction of equinus deformity in cerebral palsy.J Bone Joint Surg Am. 1958; 40: 1359-1379
- Triple arthrodesis: twenty-five and forty-four-year average follow-up of the same patients.J Bone Joint Surg Am. 1999; 81: 1391-1402
- Warning: serious complications caused by the routine rerouting of the peroneus longus and brevis tendon in performing Grice procedure in cerebral palsy.J Bone Joint Surg Am. 1974; 56: 1304-1307
- A combined bony and soft-tissue tarsal stabilization procedure (Grice-Schede) for hindfoot valgus in children with cerebral palsy.Arch Orthop Trauma Surg. 1994; 113: 237-243
- Treatment of valgus hindfoot in cerebral palsy by peroneus brevis lengthening.Dev Med Child Neurol. 1984; 26: 335-340
- Calcaneal osteotomy for valgus and varus deformities of the foot in cerebral palsy. A preliminary report on twenty-seven operations.J Bone Joint Surg Am. 1967; 49: 232-246
- Management of valgus hindfoot deformity in pediatric cerebral palsy patients by medial displacement osteotomy.J Pediatr Orthop. 1993; 13: 180-183
- Calcaneal lengthening for valgus deformity of the hindfoot. Results in children who had severe, symptomatic flatfoot and skewfoot.J Bone Joint Surg Am. 1995; 77: 500-512
- Lateral column lengthening as treatment for planovalgus foot deformity in ambulatory children with spastic cerebral palsy.J Pediatr Orthop. 2000; 20: 501-505
- Subtalar arthroereisis for the correction of planovalgus foot in children with neuromuscular disorders.J Pediatr Orthop. 1998; 18: 294-298
- The late results of arthrodesis of the foot.J Bone Joint Surg Br. 1951; 33: 496-502
- Triple arthrodesis in the young child.Clin Orthop Relat Res. 1970; 70: 187-190
- Long-term follow-up of triple arthrodesis in patients with cerebral palsy.J Pediatr Orthop. 1993; 13: 713-716
- Triple arthrodesis. A critical long-term review.J Bone Joint Surg Br. 1986; 68: 260-265
- The influence of subtalar and triple arthrodesis on the tibiotalar joint. A long-term follow-up study.J Bone Joint Surg Br. 1997; 79: 644-647
- Rigid valgus foot due to talocalcaneal bridge.J Bone Joint Surg Am. 1955; 37: 169-183
- Further experience with Grice subtalar arthrodesis.Clin Orthop Relat Res. 1986; : 113-121
- Subtalar extra-articular arthrodesis: a preliminary report of a method of stabilizing feet in children.J Bone Joint Surg Am. 1957; 39: 501-512
- Early stabilizing operation for spastic talipes equino-valgus by Grice’s extra-articular osteoplastic subtalar arthrodesis.Acta Orthop Scand. 1962; 32: 485-491
- Subtalar extra-articular arthrodesis for correction of paralytic valgus deformity of the foot. Evaluation of forty-four procedures with particular reference to associated tendon transference.J Bone Joint Surg Am. 1965; 47: 1310-1314
- The results of extra-articular subtalar arthrodesis according to the Green-Grice method in cerebral palsy.Acta Orthop Scand. 1974; 45: 945-951
- Grice Arthrodesis in Nonparalytic Flexible Flat Feet.Georg Thieme, Stuttgart1980
- Alterations in talar morphology associated with adult flatfoot.Foot Ankle Int. 1997; 18: 705-709
- Ankle valgus after the Grice subtalar stabilization: the late evaluation of a personal series with a modified technic.Clin Orthop Relat Res. 1968; 59: 137-146
Article info
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Financial Disclosure: None reported.
Conflict of Interest: None reported.
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© 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
