What is the Murphy procedure and what is it used for?

• A. Achilles tendon lengthening for spastic equinus
• B. Achilles advancement for spastic equinus in cerebral palsy
• C. Posterior tibial tendon transfer for cavus
• D. Ankle fusion for severe arthritis

Answer: (B)

The main idea is a specific Achilles tendon procedure used to correct spastic equinus in cerebral palsy. The Murphy procedure is an advancement of the Achilles tendon, not a simple lengthening. By advancing the tendon, the mechanics of the plantarflexors are altered to allow more ankle dorsiflexion during gait while aiming to preserve as much plantarflexion strength as possible. This makes it a useful option when you want to reduce the equinus deformity without sacrificing push-off power as much as a full lengthening might.

This differs from a straightforward Achilles tendon lengthening, which is a different technique and can weaken push-off more. The other choices describe procedures for different problems—posterior tibial tendon transfer for cavus foot, and ankle fusion for severe arthritis—so they don’t apply to spastic equinus in CP.