Aim of study: To assess ankle dorsiflexion of operated pedes equinovari congenitales in both clinical examination and gait analysis.

Introduction: Mac Kay subtalar release corrects mostly perfectly deformed feet. Operated feet show however stiffness not only in subtalar but as well as in ankle joint. The range of motion in ankle joint was not yet studied systematically at all. Gait analysis offers the possibility to follow the motion in ankle joint dynamically.

Material: Thirty six consecutively operated feet were examined by clinical as well as by gait analysis examination. All were operated by Mac Kay procedure at least one year before examination (range 1–7 years). Feet were examined in lying and stance positions. Gait analysis was based on use of Oxford foot model (8 cameras motion capture system).

Results: Dorsiflexion/plantiflexion of the foot estimated by clinical examination was compared with maximum dorsiflexion in phase of mid-stance (second rocker)/maximum plantiflexion in pre-swing phase (third rocker). Differences individually for each patients in dorsiflexion/plantiflexion were calculated. Mean of difference between dorsiflexion in clinical examination and dorsiflexion in gait analysis x = 14.3°. Mean of diference between plantiflexion in clinical examination and plantiflexion in gait analysis x= 5,4°. Using T-paired test these differences were found statistically significant (p=0,01). Normal maximum dorsiflexion of the children’ foot in gait analysis is about 20°. From this point 14 operated feet out from 36 did not fulfill this criterion. On the other hand only 4 operated feet showed in gait analysis dorsiflexion less than 10°.

Discussion: Dorsiflexion of the foot is important for smooth gait. The diference between dates from clinical examination and dates from gait lab can be explained by weight - bearing force pushing the foot into dorsiflexion during second rocker or by secondary adaptive intrinsic bending of the foot

Conclusion: Operated feet showed moderate/severe stiffnes of ankle joint. Despite of it, the gait cycle was not significantly impaired.

Aim: To introduce a mini-invasive surgical treatment for lengthening of knee flexors in cerebral palsied children.

Material and methods: Operation is performed in prone position under tourniquet control. The trocar (4mm) is introduced from middle thirds of dorsal surface of the thigh in the direction caudally from small incision. By means of the trocar soft tissues are separated from the superficial fascia and a working tunnel is created. Then optical system is introduced and gas (CO2) is pushed in. Under the guidance of the videoscopic system another two small incision are done, one medially one laterally. By means of the knife blade and arthroscopic scissors the superficial fascia is divided and musculotendinous junction of gracilis and semitendinosus is found and muscular recession is done. The aponeurosis of semi-membranosus is isolated and transversely cut. When necessary, from second mini-incision the aponeurosis of biceps femoris is isolated and cut. Operation method was prepared on a cadaver study, concerning the learning curve, for the operation were selected patients with only moderate flexion contracture, Bleck angle between 50–60°.

Results: In 5 operated legs videoscopic tenotomy resulted in full correction of fixed flexion. Small incisions healed uneventfully. No vascular or neurological complications were registered.

Discussion: Videoscopic technique firstly was used in our institution for correction of fixed equinus in CP patients. Concerning good results and acquired operation technique, obtained experience was used for correction of fixed flexion contracture.

Conclusion: Videoscopic correction of fixed knee flexion in CP seems to be a safe and reliable operation method.

In this prospective study, 35,550 neonates were examined shortly after birth by a team of orthopaedic surgeons. They diagnosed 775 unstable or dislocated hips in 656 babies; there were two teratological dislocations. Treatment was first with a Frejka pillow and, if this failed to give a normal hip, a Pavlik harness at three months. Early clinical examination did not identify 21 infants who were found to have subluxation or dislocation of the hip at the three-month review. The number of missed cases declined during the study, however, reflecting the increasing experience of the examiners. One case of avascular necrosis occurred in the group treated from birth and one in the late-diagnosed group. Open reduction was necessary only in the two teratological dislocations. Experienced examiners are needed for accurate clinical diagnosis; and treatment should be started before the baby is discharged from the maternity ward.