Heel cord advancement has been advocated for treatment of spastic equi
nus deformity. Transferring the gastrosoleus anteriorly weakens it by
changing the lever arm rather than the resting length. A retrospective
review of 90 children with 122 limbs undergoing heel cord advancement
revealed 11% excellent, 53% good, and 35% poor results (average follo
w-up 9.7 years). The results were statistically better in diplegics an
d community walkers. The better results in previous studies may be due
to procedure modifications and shorter follow-up. Since we obtain com
parable results with simlper heel cord lengthenings, we no longer do h
eel cord advancement.