Biomechanically Based Clinical Decision Making in Pediatric Foot and Ankle Surgery

The understanding and classification of functional deviations and deficits at the ankle and foot are based upon an appreciation of normal function during the gait cycle. Clinical decision making for the management of ankle and foot deformities in children can be standardized by the use of a diagnostic matrix. This chapter provides an overview of normal ankle and foot function during the gait cycle. A diagnostic matrix is then constructed for the identification of common (or coupled), and uncommon (or uncoupled), segmental malalignment patterns of the ankle and foot. This is followed by an overview (principles and indications) of the most common soft tissue (lengthening and transfer) and skeletal (guided growth, osteotomies, and arthrodesis) surgeries utilized to correct these segmental malalignments. Finally, a standardized approach for the preoperative, intraoperative, postoperative, and surveillance assessment of ankle and foot alignment and function is presented.