The Baumann procedure for fixed contracture of the gastrosoleus in cerebral palsy - Evaluation of function of the ankle after multilevel surgery

We treated 22 children (28 limbs) with diplegic cerebral palsy who were abl e to walk by the Baumann procedure for correction of fixed contracture of t he gastrosoleus as part of multilevel single-stage surgery to improve gait. The function of the ankle was assessed by clinical examination and gait an alysis before and at two gears (2.1 to 4.0) after operation. At follow-up t he ankle showed an increase in dorsiflexion at initial contact, in single s tance and in the swing phase. There was an increase in dorsiflexion at init ial push-off without a decrease in the range of movement of the ankle, and a significant improvement in the maximum flexor moment in the ankle in the second half of single stance, There was also a change from abnormal generat ion of energy in mid-stance to the normal pattern of energy absorption. Pos itive work during push-off was significantly increased. Lengthening of the gastroenemius fascia by the Baumann procedure improved the function of the ankle significantly, and did not result in weakening of the triceps surae, We discuss the anatomical and mechanical merits of the procedure.