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Kanetani K, Kimura T, Yamashita N, Kisamori K, Saito M, Kubota M. Correction of Equinus Deformity by Ilizarov Frame Using the Matsushita Method and Achilles Tendon Lengthening: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00018. [PMID: 38669349 DOI: 10.2106/jbjs.cc.23.00324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
CASE The patient was an 18-year-old man who had sustained diaphyseal fractures of the left femur and tibia in a traffic accident and underwent surgery at another hospital. A severe left foot equinovarus deformity developed in the early after surgery. The patient's left foot deformity was addressed using unconstrained gradual external fixator correction (the Matsushita method) in combination with soft-tissue contracture through Achilles tendon lengthening and was maintained after removing the external fixation. CONCLUSION The Matsushita method can be effective in the correction of post-traumatic equinovarus foot deformities.
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Affiliation(s)
- Komei Kanetani
- Department of Orthopedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Chee SY, McKenna J, Shelley OP. Tibialis Posterior Tendon Transfers to Correct Bilateral Postburn Ankle Equinus: A Case Report. Ann Plast Surg 2021; 86:632-634. [PMID: 33661225 DOI: 10.1097/sap.0000000000002779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Treatment of joint contractures after burn injury is challenging because various factors influence the treatment options including the lack of local tissue, significant fibrotic changes with associated loss of joint pliability, increased prevalence of infection in burn patients, and patient-related medical comorbidities.We present a case of a 60-year-old woman who had severe bilateral postburn ankle equinus deformities after self-immolation in the setting of significant soft tissue injury, fibrosis, and loss of joint movement. This deformity deprived her of the ability to walk, even aided, and she was unable to progress with her rehabilitation. We used the tibialis posterior tendon transfer to completely correct her postburn ankle equinus allowing for the restoration of both her feet to a neutral position, which enabled the patient to walk unaided after the surgery. This is a simple and effective solution to a complex problem when soft tissue reconstruction is limited. Patients with this complication are wheelchair dependent, and we suggest that posterior tibialis transfer should be considered as a surgical intervention for burns with severe equinus contracture even if there is a fixed deformity to allow for their full rehabilitation after injury.
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Ma N, Sclavos N, Passmore E, Thomason P, Graham K, Rutz E. Three-Dimensional Gait Analysis in Children Undergoing Gastrocsoleus Lengthening for Equinus Secondary to Cerebral Palsy. Medicina (Kaunas) 2021; 57:98. [PMID: 33499373 PMCID: PMC7911110 DOI: 10.3390/medicina57020098] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Equinus is the most common deformity in children with cerebral palsy, and surgical lengthening of the gastrocsoleus muscle-tendon unit is the most commonly performed operation for children with cerebral palsy. Treatment outcomes of orthopaedic surgery can be measured objectively with three-dimensional gait analysis. This study examined the quality of evidence for gastrocsoleus lengthening surgery based on objective measures. Materials and Methods: A search was performed with Medline, Embase and PubMed from 1990 to 25 August 2020 using the keywords "cerebral palsy", "equinus", "surgery" and "gait analysis". Only studies of gastrocsoleus lengthening surgery using three-dimensional gait analysis were included, yielding 34 studies. Results: Fourteen studies reported swing phase kinematics and all studies reported a significant improvement. Rates of recurrent equinus and calcaneus were reported in 21 studies and varied widely based on follow-up period and surgical technique. Conclusions: Poor study quality and marked variability in study samples and interventions made comparison difficult. Future studies should consider prospective design, controls or comparison groups and more detailed breakdowns of outcomes by cerebral palsy subtype, sagittal gait pattern, and equinus type in order to allow more rigorous treatment recommendations to be made.
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Affiliation(s)
- Norine Ma
- Australia and Hugh Williamson Gait Laboratory, Pediatric Orthopedic Department, The Royal Children’s Hospital, Parkville, Melbourne, VIC 3052, Australia; (N.M.); (N.S.); (E.P.); (P.T.); (K.G.)
| | - Nicholas Sclavos
- Australia and Hugh Williamson Gait Laboratory, Pediatric Orthopedic Department, The Royal Children’s Hospital, Parkville, Melbourne, VIC 3052, Australia; (N.M.); (N.S.); (E.P.); (P.T.); (K.G.)
| | - Elyse Passmore
- Australia and Hugh Williamson Gait Laboratory, Pediatric Orthopedic Department, The Royal Children’s Hospital, Parkville, Melbourne, VIC 3052, Australia; (N.M.); (N.S.); (E.P.); (P.T.); (K.G.)
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Pam Thomason
- Australia and Hugh Williamson Gait Laboratory, Pediatric Orthopedic Department, The Royal Children’s Hospital, Parkville, Melbourne, VIC 3052, Australia; (N.M.); (N.S.); (E.P.); (P.T.); (K.G.)
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Kerr Graham
- Australia and Hugh Williamson Gait Laboratory, Pediatric Orthopedic Department, The Royal Children’s Hospital, Parkville, Melbourne, VIC 3052, Australia; (N.M.); (N.S.); (E.P.); (P.T.); (K.G.)
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Erich Rutz
- Australia and Hugh Williamson Gait Laboratory, Pediatric Orthopedic Department, The Royal Children’s Hospital, Parkville, Melbourne, VIC 3052, Australia; (N.M.); (N.S.); (E.P.); (P.T.); (K.G.)
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
- Medical Faculty, The University of Basel, 4001 Basel, Switzerland
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Gaytán-Fernández S, Chaidez P, García-Galicia A, Martínez-Asención P, Barragán-Hervella RG, Corpus-Mariscal E, Jiménez-Reyes M, Montiel-Jarquín AJ. [Analysis to determine optimal age for surgical management of equinus foot in patients with childhood cerebral palsy]. Acta Ortop Mex 2020; 34:2-5. [PMID: 33230991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Childhood cerebral palsy, a non-progressive brain injury, occurs before, during or after delivery, with variable neurological damage from mild to disabling. The deformity in equine is treated conservatively at an early age, but when is surgical management indicated? OBJECTIVE Our goal was to determine the optimal age for surgical management of the equine foot in CCP patients. MATERIAL AND METHODS Retrospective study, in patients diagnosed with CCP (all types), treated surgically with open or percutaneous Achilles tendon elongation, assessed with external consultation notes, in patients aged 1-16 years, and average follow-up of 6 years, evaluating progress with relapse of deformity and gait with plantigrade support. RESULTS 55 patients, 74 equinus feet (29 in girls, 45 in boys) were analyzed with surgical treatment. Those treated before six years old presented relapses, with vulnerable period in 4-6 years. Monoplegia presented 100% relapses, and triplegia presented 0%. Open surgery presented 50% recurrence and percutaneous technique only 19%. CONCLUSION In our institution, the optimal age is suggested in 6-12 years. Percutaneous technique over the open, should be preferred, and greater attention should be paid to monitoring monoplexy.
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Affiliation(s)
- S Gaytán-Fernández
- Unidad Médica de Alta Especialidad del Hospital de Traumatología y Ortopedia de Puebla, Centro Médico Nacional «Gral. de Div. Manuel Ávila Camacho» del Instituto Mexicano del Seguro Social. Puebla, Puebla. México
- Hospital Shriners para Niños. Ciudad de México. México
| | - P Chaidez
- Hospital Shriners para Niños. Ciudad de México. México
| | - A García-Galicia
- Unidad Médica de Alta Especialidad del Hospital de Traumatología y Ortopedia de Puebla, Centro Médico Nacional «Gral. de Div. Manuel Ávila Camacho» del Instituto Mexicano del Seguro Social. Puebla, Puebla. México
| | - P Martínez-Asención
- Unidad Médica de Alta Especialidad del Hospital de Traumatología y Ortopedia de Puebla, Centro Médico Nacional «Gral. de Div. Manuel Ávila Camacho» del Instituto Mexicano del Seguro Social. Puebla, Puebla. México
| | - R G Barragán-Hervella
- Unidad Médica de Alta Especialidad del Hospital de Traumatología y Ortopedia de Puebla, Centro Médico Nacional «Gral. de Div. Manuel Ávila Camacho» del Instituto Mexicano del Seguro Social. Puebla, Puebla. México
| | - E Corpus-Mariscal
- Unidad Médica de Alta Especialidad del Hospital de Traumatología y Ortopedia de Puebla, Centro Médico Nacional «Gral. de Div. Manuel Ávila Camacho» del Instituto Mexicano del Seguro Social. Puebla, Puebla. México
| | - M Jiménez-Reyes
- Unidad Médica de Alta Especialidad del Hospital de Traumatología y Ortopedia de Puebla, Centro Médico Nacional «Gral. de Div. Manuel Ávila Camacho» del Instituto Mexicano del Seguro Social. Puebla, Puebla. México
- Facultad de Medicina de la Universidad Popular Autónoma del Estado de Puebla. Puebla, México
| | - A J Montiel-Jarquín
- Unidad Médica de Alta Especialidad del Hospital de Traumatología y Ortopedia de Puebla, Centro Médico Nacional «Gral. de Div. Manuel Ávila Camacho» del Instituto Mexicano del Seguro Social. Puebla, Puebla. México
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Chen W, Liu X, Pu F, Yang Y, Wang L, Liu H, Fan Y. Conservative treatment for equinus deformity in children with cerebral palsy using an adjustable splint-assisted ankle-foot orthosis. Medicine (Baltimore) 2017; 96:e8186. [PMID: 28984769 PMCID: PMC5738005 DOI: 10.1097/md.0000000000008186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 01/19/2017] [Accepted: 09/07/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A novel splint, the assisting ankle-foot orthoses (AFO), was developed to provide adjustable sustained stretching to improve conservative treatment for equinus deformities in children with cerebral palsy (CP). The treatment effect was validated by follow-up visits. METHODS This study involved subjects between 2 and 12 years old, including 28 CP children treated with splint-assisted AFO correction, 30 CP children treated with static AFO correction, and 30 normal children with typical development (TD). Quantitative pedobarographic measurements were taken to evaluate the effect of splint-assisted AFO correction. The heel/forefoot ratio was introduced to indicate the degree of the equinus deformity during treatment. RESULTS The results showed that the heel/forefoot ratios were 1.41 ± 0.26 for the TD children; 0.65 ± 0.41, 1.02 ± 0.44, and 1.24 ± 0.51 for the splint-assisted AFO correction before and after 6-month and 12-month treatments; 0.59 ± 0.37, 0.67 ± 0.44, and 0.66 ± 0.42 for the static AFO correction before and after 6-month and 12-month treatments. CONCLUSIONS This study suggests that correction with the adjustable splint-assisted AFO is an effective treatment for equinus deformity in CP Children.
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Affiliation(s)
- Wei Chen
- Key Laboratory of Rehabilitation Technical Aids, Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University
| | - Xiaoyu Liu
- Key Laboratory of Rehabilitation Technical Aids, Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University
| | - Fang Pu
- Key Laboratory of Rehabilitation Technical Aids, Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University
- State Key Laboratory of Virtual Reality Technology and Systems, Beihang University
| | - Yang Yang
- Key Laboratory of Rehabilitation Technical Aids, Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University
| | - Lizhen Wang
- Key Laboratory of Rehabilitation Technical Aids, Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University
| | - Hong Liu
- Rokab Pedorthic Center, Beijing, P.R. China
| | - Yubo Fan
- Key Laboratory of Rehabilitation Technical Aids, Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University
- State Key Laboratory of Virtual Reality Technology and Systems, Beihang University
- National Research Center for Rehabilitation Technical Aids
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Blazquez Martin T, Martinez Nisa C, Dodangeh Gonzalez M, San Miguel-Campos M. Letter to the editor on "A standard shoelace prevents equinus posturing of the ankle during circular external fixation of the tibia". Foot Ankle Surg 2016; 22:214-215. [PMID: 27502234 DOI: 10.1016/j.fas.2015.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/03/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Teresa Blazquez Martin
- Department of Foot and Ankle, Hospital Monográfico Asepeyo de Traumatología, Cirugía Ortopédica y Rehabilitación.
| | - Cristina Martinez Nisa
- Department of Foot and Ankle, Hospital Monográfico Asepeyo de Traumatología, Cirugía Ortopédica y Rehabilitación
| | - Miguel Dodangeh Gonzalez
- Department of Foot and Ankle, Hospital Monográfico Asepeyo de Traumatología, Cirugía Ortopédica y Rehabilitación
| | - Manuel San Miguel-Campos
- Department of Foot and Ankle, Hospital Monográfico Asepeyo de Traumatología, Cirugía Ortopédica y Rehabilitación
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Mencière ML, Ferraz L, Mertl P, Vernois J, Gabrion A. Arthroscopic tibiotalocalcaneal arthrodesis in neurological pathologies: outcomes after at least one year of follow up. Acta Orthop Belg 2016; 82:106-111. [PMID: 26984662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The main complications of open tibiotalocalcaneal arthrodesis are wound healing disorders and nonunion. Our hypothesis was that arthroscopy and interlocking intramedullary nailing decrease these complications. We retrospectively reviewed six patients (mean age: 58 years; mean preoperative Kitaoka score: 51/100) having undergone arthroscopic tibiotalocalcaneal arthrodesis with retrograde intramedullary nailing between January and November 2011 for equinus deformity of the hindfoot and subtalar instability of neurological origin. Postoperative pain disappeared completely in four cases, one patient presented some pain associated with projection of the proximal locking screw head under the skin and the remaining patient presented fibular tendinitis that resolved after infiltration of anti-inflammatory drugs. The mean postoperative Kitaoka score was 64/100. None of the patients presented any wound healing complications or nonunion. The observed incidence of wound complications and bone consolidation disorders after tibiotalocalcaneal arthrodesis was lower than the ones reported for open tibiotalocalcaneal arthrodesis. Level of clinical evidence IV: retrospective case series.
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Yoshikawa M, Nakanishi Y, Kawamura Y, Matsuo K, Saeki M, Wada F. Stress fracture of the navicular bone in a patient with cerebral palsy: a case report. J UOEH 2015; 37:11-15. [PMID: 25787097 DOI: 10.7888/juoeh.37.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 14-year-old girl with cerebral palsy (spastic diplegia) underwent examination due to a chief complaint of right foot pain, and was diagnosed with a stress fracture of the central one third of the navicular bone. The fracture was considered to have developed due to repeated loading on the navicular bone as a result of an equinus gait.Therefore, she underwent osteosynthesis and Achilles tendon lengthening to correct the equinus deformity. Following our review of the current literature, we did not identify any reports of stress fracture of the navicular bone in cerebral palsy. We believe that in cases where cerebral palsy patients with paralytic equinus complain of foot pain, the possibility of stress fracture of the navicular bone should be considered.
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Affiliation(s)
- Mari Yoshikawa
- Department of Rehabilitation Medicine, Kitakyushu Rehabilitation Center for Children with Disabilities, Japan
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Picelli A, Tamburin S, Cavazza S, Scampoli C, Manca M, Cosma M, Berto G, Vallies G, Roncari L, Melotti C, Santilli V, Smania N. Relationship between ultrasonographic, electromyographic, and clinical parameters in adult stroke patients with spastic equinus: an observational study. Arch Phys Med Rehabil 2014; 95:1564-70. [PMID: 24792138 DOI: 10.1016/j.apmr.2014.04.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/10/2014] [Accepted: 04/12/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To find more accurate indices that could affect decisions in spasticity treatment by investigating the relation between ultrasonographic, electromyographic, and clinical parameters of the gastrocnemius muscle in adults with spastic equinus after stroke. DESIGN Observational study. SETTING University hospitals. PARTICIPANTS Chronic patients with stroke with spastic equinus (N=43). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Ultrasonographic features were spastic gastrocnemius muscle echo intensity, muscle thickness, and posterior pennation angle of the gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) in both legs. Electromyographic evaluation included compound muscle action potentials (CMAPs) recorded from the GM and GL of both legs. Clinical assessment of the spastic gastrocnemius muscle was performed with the Modified Ashworth Scale (MAS) and by measuring ankle dorsiflexion passive range of motion (PROM). RESULTS Spastic muscle echo intensity was inversely associated with proximal (GM and GL: P=.002) and distal (GM and GL: P=.001) muscle thickness, pennation angle (GM: P< .001; GL: P=.01), CMAP (GM: P=.014; GL: P=.026), and ankle PROM (GM: P=.038; GL: P=.024). The pennation angle was directly associated with the proximal (GM and GL: P< .001) and distal (GM: P=.001; GL: P< .001) muscle thickness of the spastic gastrocnemius muscle. The MAS score was directly associated with muscle echo intensity (GM: P=.039; GL: P=.027) and inversely related to the pennation angle (GM and GL: P=.001) and proximal (GM: P=.016; GL: P=.009) and distal (GL: P=.006) muscle thickness of the spastic gastrocnemius. CONCLUSIONS Increased spastic muscle echo intensity was associated with reduced muscle thickness, posterior pennation angle, and CMAP amplitude in the gastrocnemius muscle. Building on previous evidence that these instrumental features are related to botulinum toxin response, these new findings may usefully inform spasticity treatment decisions.
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Affiliation(s)
- Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Tamburin
- Neurology Section, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | | | | | - Mario Manca
- Motion Analysis Laboratory, San Giorgio Hospital, Ferrara, Italy
| | - Michela Cosma
- Motion Analysis Laboratory, San Giorgio Hospital, Ferrara, Italy
| | - Giulia Berto
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Gabriella Vallies
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Laura Roncari
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Camilla Melotti
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Valter Santilli
- Physical Medicine and Rehabilitation, Department of Orthopedic Science, Sapienza University of Rome, Rome, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy; Neurological Rehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
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Gavriliu S, Georgescu I, Ulici A, Ghita R, Japie EM, Pandea N, Pârvan A, Burnei C, Tiripa IL, Martiniuc A, Hamei S, Draghici I. Herbert capsuloplasty and Burnei tenomyoplasty for the correction of genu flexum in cerebral palsy, arthrogryposis and posttraumatic. Chirurgia (Bucur) 2013; 108:866-873. [PMID: 24331328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Studies of gait dynamics revealed the complex motions that the knee must undergo in sync with the hip and ankle, in both the swing and support phase of walking. If these motions are restricted, usually as a consequence of cerebral palsy or arthrogryposis, normal gait is hindered; the patient may be able to walk for very short distances or, eventually, not at all. Children with knee extension limited by 10 - 30 degrees,especially those with cerebral palsy, exhibit a stance compatible with walking. Walking is difficult and the gait pattern, "crouch gait", is considered typical for this degree of limitation. AIM This paper is meant as an update regarding the usefulness of Herbert knee capsuloplasty, conceived in 1938 and introduced in Romania in 1956 by Clement Baciu, and Burneidistal medial hamstring tenomyoplasty, invented in 1993. MATERIALS AND METHODS Herbert knee capsuloplasty, although initially intended for ailments other than spasticity or arthrogryposis,became known, in time, as a useful operation for spastic genu flexum with a 15 to 30 degree limitation of extension. Severing the posterior cruciate ligament (PCL) in children less than 10 years old often results in genu recurva tumor joint instability. In order to avoid these complications, PCL transection has been phased out and our clinic started to use, preferentially for spastic genu flexum rather than arthrogryposis,the Burnei tenomyoplasty. When applied in the same operative session, the two techniques complement each other and act in synergy. RESULTS Herbert capsuloplasty can achieve only partial correction of genu flexum ranging between 30 and 60 degrees of extension deficit. Full extension is opposed by the PCL,contracture of the hamstrings and vascular retraction. Burnei tenomyoplasty used by itself is useful for genu flexum with less than 30 degrees of extension deficit. For children with 30 to 60 degrees of knee extension deficit, combining the Herbertand Burnei procedures achieves the best results. CONCLUSIONS The simultaneous application of Herbert capsuloplasty and Burnei tenomyoplasty allows for the correction of stiff genu flexum and enables the patient to resume walking,with or without support. This course of treatment also avoids the progression of genu flexum beyond 60 degrees, which would require an osteotomy. This combined procedure avoids the cartilage lesions which may develop when patients with 30- 60 degree genu flexum undergo Herbert capsuloplasty alone.Not in the least, the risk of postoperative knee dislocation is significantly reduced.
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Abstract
BACKGROUND This study was performed to investigate anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity in patients with residual poliomyelitis and to investigate whether the severity of preoperative equinus deformity affected the occurrence of symptomatic anterior impingement. METHODS Twenty-seven consecutive patients (mean age, 43.8 ± 9.4 years) with residual poliomyelitis who underwent tendo-Achilles lengthening for equinus foot deformity were included. On lateral foot-ankle weight-bearing radiographs, the tibiocalcaneal angle, plantigrade angle, and McDermott grade were measured and the presence of anterior blocking spur was evaluated. RESULTS Eleven patients (40.7%) had anterior ankle impingement on radiographic findings preoperatively and 24 patients (88.9%) at latest follow-up. There was a significant difference in McDermott grade between preoperative and latest follow-up (P < .001). There were significant differences in tibiocalcaneal angle and plantigrade angle between the patients with anterior ankle pain and without anterior ankle pain (P = .006 and .011, respectively) and between the patients with anterior blocking spur and without anterior blocking spur (P = .005 and .010, respectively). CONCLUSIONS Most patients with residual poliomyelitis had anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity, and the presence of symptomatic anterior ankle impingement was significantly associated with the severity of the equinus deformity. Therefore, for residual poliomyelitis patients with severe long-standing equinus deformity, surgeons should consider the possibility of a subsequent anterior procedure for anterior impingement after tendo-Achilles lengthening. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Ki Hyuk Sung
- Kwandong University Myongji Hospital, Kyungki, Goyang, Korea
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Eyesan SU, Olawepo A, Obalum DC, Oyenusi AS, Igbinoba BA, James JA, Abdulkareem FB. Deep calf cavernous haemangioma in a 10 year- old girl: a case report. Niger Postgrad Med J 2013; 20:162-164. [PMID: 23959360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Haemangiomas are abnormal proliferation of blood vessels in any vascularised tissue. They can be capillary or cavernous varieties. Cavernous are either of cutaneous or deep types. Cavernous when compared with the capillary haemangioma is rare. Rarer still is the deep type of cavernous haemangioma. This is a report of a 10 year old Nigerian girl who presented with a right posterior leg swelling of 8 year duration, size initially was that of a peanut but increased to fill the entire calf region causing pain to the patient as well as cosmetic and anxiety concern to the parents. No preceding history of trauma, no associated systematic symptoms. She had exploratory laparatomy at 1 year of age at a private hospital for an abdominal mass which was excised. Pre-operative plain radiograph, Magnetic Resonance Imaging(MRI), Abdominopelvic ultrasound scan (USS) were done, fine needle aspiration cytology (FNAC) though done was not helpful. Histo-pathology result of excised leg mass confirmed diagnosis; there was a free margin of excision. Post-operatively, clinical improvement was marked.
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Affiliation(s)
- S U Eyesan
- Department of Orthopaedics and Trauma Suegery, National Orthopaedic Hospital, P.M.B 2009 Yaba 101212, Lagos, Nigeria
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Benedetti MG, D'Apote G, Faccioli S, Costi S, Ferrari A. Equinus foot classification in cerebral palsy: an agreement study between clinical and gait analysis assessment. Eur J Phys Rehabil Med 2011; 47:213-221. [PMID: 21508920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Excessive ankle plantar flexion (equinus foot) is a common problem in cerebral palsy (CP) and several treatment options can be considered depending on the equinus type. Few attempts have been made to classify different forms of equinus foot for specific treatment. AIM This study is aimed at defining equinus foot types in CP patients according to the Ferrari classification, integrating clinical and instrumental assessments. The hypothesis is that clinical differentiation of equinus foot can be evidenced by recurrent anomalies identifiable through gait analysis (GA), which can make the assessment, usually based only on clinician semeiotics, more objective. DESIGN Clinical and instrumental assessments were performed separately by a senior CP physiatrist and a senior GA physiatrist, the latter was blind to the clinical diagnosis of equinus type. SETTING Outpatients POPULATION Twenty patients, 16 diplegics and 4 hemiplegics (mean age 11 years, SD 4 years 11 months). METHODS Clinical assessment by means of Modified Ashworth Scale, Gross Motor Function Measure (GMFM), Observational Gait Analysis (OGA), and measurement of lower limb muscle strength by dynamometer were used to classify the equinus type. Gait analysis assessed the kinematics and EMG of affected lower limbs. RESULTS Ten different equinus types were identified. Since various forms of equinus can be present in the same patient, we were able to classify a total of 61 types of equinus in 36 feet. Substantial agreement was found between Clinical and Gait Analysis equinus assignment matched in 50 out of 61 types (Index of agreement with Fleiss' Kappa 79.3 % ). In some case only Gait Analysis was able to identify the equinus type, while in others it did not confirm clinical assignment. CONCLUSION Gait analysis is able to distinguish different equinus types according to Ferrari classification, making the clinical decision less arbitrary. CLINICAL REHABILITATION IMPACT Correct objective diagnosis of equinus foot in CP patients is of paramount importance when choosing suitable rehabilitative interventions.
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Affiliation(s)
- M G Benedetti
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy.
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Trč T, Havlas V, Rybk D. [Baker's procedure in the treatment of pes equinus in cerebral palsy patients]. Acta Chir Orthop Traumatol Cech 2011; 78:232-236. [PMID: 21729639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE OF THE STUDY Surgical procedures on muscles in cerebral palsy are regarded as essential interventions. The tactics for surgery on the triceps surae muscle in the treatment of spastic pes equinus involve several surgical options at different muscle levels. MATERIAL AND METHODS In the 1992-2008 period, Baker's procedure, prolongation of the triceps muscle in the common part of the gastrocnemius and soleus aponeuroses, was indicated in 114 children, aged between 3 and 18 years, mostly with spastic hemipleia (45.7 %) or diplegia (42.9 %). In both groups, the isolated Baker's procedures and the combined procedures were clinically assessment at 2 and 6 months after surgery. RESULTS Clinical examination at a follow-up of 8 weeks showed that all patients achieved 5 to 10 degrees of dorsiflexion of the foot. A maximum of Achilles tendon stretch-out was achieved in seven patients (6.14%) after 6 months. In one patient (0.9%) an excessive dorsiflexion was recorded. DISCUSSION The choice of surgical tactics for treatment of spastic pes equinus is related to a positive or a negative result of the Silfverskiold test, because this shows the degree of contracture of the gastrocnemius and soleus muscles. Prolongation at their joint aponeurosis should be indicated when the test shows partly positive results, and muscle balance at all levels of the lower extremity should be maintained. CONCLUSIONS Baker's procedure is one of the options to treat spastic pes equinus. The surgery is indicated primarily in isolated pes equinus and in children with spastic hemiplegia with low risk of Achilles tendon excessive elongation. Key words: pes equinus, Silfverskiold test, Baker's procedure.
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Affiliation(s)
- T Trč
- Ortopedická klinika 2. LF UK a FN v Motole - Dětská a dospělá ortopedie a traumatologie
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Abstract
BACKGROUND Reduced ankle dorsiflexion range of motion, or ankle equinus, is a common and disabling problem for patients with neuromuscular disease. Clinicians devote considerable time and resources implementing interventions to correct this problem although few of these interventions have been subject to rigorous empirical investigation. OBJECTIVES To assess the effect of interventions to reduce or resolve ankle equinus in people with neuromuscular disease. SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Group Trials Specialized Register (August 2009), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2009), MEDLINE (1966 to August 2009), EMBASE (1980 to August 2009), CINAHL 1982 to August 2009), AMED (1985 to August 2009) and The Physiotherapy Evidence Database (PEDro) (1929 to August 2009). We searched the reference lists of identified articles and also contacted known experts in the field to identify additional or unpublished data. SELECTION CRITERIA Randomised controlled trials evaluating interventions for increasing ankle dorsiflexion range of motion in neuromuscular disease. Outcomes included ankle dorsiflexion range of motion, functional improvement, foot alignment, foot and ankle muscle strength, health-related quality of life, satisfaction with the intervention and adverse events. DATA COLLECTION AND ANALYSIS Two authors independently selected papers, assessed trial quality and extracted data. MAIN RESULTS Four studies involving 149 participants met inclusion criteria for this review. Two studies assessed the effect of night splinting in a total of 26 children and adults with Charcot-Marie-Tooth disease type 1A. There were no statistically or clinically significant differences between wearing a night splint and not wearing a night splint. One study assessed the efficacy of prednisone treatment in 103 boys with Duchenne muscular dystrophy. While a daily dose of prednisone at 0.75 mg/kg/day resulted in significant improvements in some strength and function parameters compared with placebo, there was no significant difference in ankle range of motion between groups. Increasing the prednisone dose to 1.5 mg/kg/day had no significant effect on ankle range of motion. One study evaluated early surgery in 20 young boys with Duchenne muscular dystrophy. Surgery resulted in increased ankle dorsiflexion range at 12 months but functional outcomes favoured the control group. By 24 months, many boys in the surgical group experienced a relapse of achilles tendon contractures. AUTHORS' CONCLUSIONS There is no evidence of significant benefit from any intervention for increasing ankle range of motion in Charcot-Marie-Tooth disease type 1A or Duchenne muscular dystrophy. Further research is required.
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Affiliation(s)
- Kristy J Rose
- Institute of Neuroscience and Muscle Research, The Children's Hospital at Westmead, Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Sydney, Australia
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Kurenkova AL, Dutikova EM, Nikitin SS, Artemenko AR. [Foot deformity in children with spastic forms of cerebral palsy: the treatment with botulinum toxin type A (dysport)]. Zh Nevrol Psikhiatr Im S S Korsakova 2010; 110:37-43. [PMID: 20559272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The objective is to study the effect of dysport injections on the clinical and electromyographic changes in 35 patients (mean age 5,3+/-2,0 years) with spastic forms of cerebral palsy (26 with spastic diplegia, 9 with hemiparetic form) with equinus and equinovarus deformity. Depending on the clinical situation, dysport was injected in a total dose of 20-30 u per 1 kg of the body mass. Gastrocnemius muscles were injected more frequently than soleus and posterior tibial muscles. The treatment resulted in the significant reduction of spasticity on the Ashworth scale, decrease of equinus deformity, positive changes in the parameters of stepping on flat foot, independent standing and walking, the beginning of support period from the heel. During the arbitrary contraction, the amplitude of bioelectrical activity of target muscles of low extremities reduced, though not to the extent of the motor activity loss; the reciprocity coefficient decreased from 0,69+/-0,32 to 0,47+/-0,28 in patients with spastic diplegia and from 0,45+/-0,34 to 0,34+/-0,25 in patients with hemiparetic form. The effect of dysport was higher in hemiparetic form compared to spastic diplegia. The best results for spastic diplegia were revealed in patients with isolated spasticity without severe disturbances of reciprocal relations in shin muscles and pathological synkinesia.
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Jaddue DAK, Abbas MA, Sayed-Noor AS. Open versus percutaneous tendo-achilles lengthening in spastic cerebral palsy with equines deformity of the foot in children. J Surg Orthop Adv 2010; 19:196-199. [PMID: 21244805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The purpose of this study was to compare open to percutaneous tendo-achilles lengthening (TAL) as treatment for equinus deformity (ED) in children with cerebral palsy (CP). Eighteen ambulatory spastic CP children (28 feet) with isolated primary fixed ED were randomized to these two methods and prospectively followed up 7 to 18 months postoperatively (mean 11 months). The study found that the percutaneous TAL gave shorter operative time, shorter hospitalization period, better active dorsal and plantarflexion abilities, better parent satisfaction, and lower complication rate. It was concluded that percutaneous TAL seemed to be superior to the open TAL regarding the studied parameters.
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Affiliation(s)
- Dhia A K Jaddue
- Department of Orthopaedic Surgery, Al-Kindy Teaching Hospital, Baghdad, Iraq
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Fock J, Galea MP, Stillman BC, Rawicki B, Clark M. Functional outcome following Botulinum toxin A injection to reduce spastic equinus in adults with traumatic brain injury. Brain Inj 2009; 18:57-63. [PMID: 14660236 DOI: 10.1080/0269905031000149498] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PRIMARY OBJECTIVE The aim of this study was to assess the effect of Botulinum toxin A in the management of spastic equinus resulting from traumatic brain injury. RESEARCH DESIGN A before-after intervention design was used without controls. METHODS AND PROCEDURES Subjects were seven patients suffering from traumatic brain injury of average duration 14 (4-38) months as a result of motor vehicle trauma, who had spastic equinus interfering with gait. EXPERIMENTAL INTERVENTION The patients were treated with injections of Botulinum toxin A into the spastic calf muscles: gastrocnemius, soleus and tibialis posterior. Assessments were made pre-injection and at 2 weeks and 3 months post-injection. MAIN OUTCOME AND RESULTS At the end of the 3-month period, all patients showed a significant improvement in gait velocity, cadence and stride length. CONCLUSIONS The findings suggest that Botulinum toxin A may be useful in the management of spastic equinus following traumatic brain injury.
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Affiliation(s)
- Jimy Fock
- Brighton Rehabilitation Centre, Victoria, Australia
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Kinsella S, Moran K. Gait pattern categorization of stroke participants with equinus deformity of the foot. Gait Posture 2008; 27:144-51. [PMID: 17467274 DOI: 10.1016/j.gaitpost.2007.03.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Revised: 03/05/2007] [Accepted: 03/14/2007] [Indexed: 02/02/2023]
Abstract
Following stroke an equinus deformity of the foot may develop, which may affect the gait pattern of patients differently. Sub-categorization of gait patterns in these patients would be helpful in developing and delivering more targeted treatment. A hierarchical cluster analysis was used to classify the gait patterns of 23 chronic stroke patients with equinus deformity of the foot based on temporal distance parameters and joint kinematic and kinetic measures in the sagittal and coronal planes. Cluster analysis showed that gait patterns were not singularly homogenous and identified three subgroups that contained within group homogenous levels of function. Further analysis identified significant differences between the subgroups in some of the temporal distance and kinematic and kinetic measures examined. The results from this study can be used to categorise patients, facilitating appropriate development of targeted treatment.
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Affiliation(s)
- Sharon Kinsella
- Department of Science and Health, School of Science, Institute of Technology, Carlow, Ireland.
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Cobeljić G, Vukasinović Z, Apostolović M, Bajin Z. [Choice of operative procedures to correct equinus deformity in patients with cerebral palsy]. ACTA ACUST UNITED AC 2007; 53:21-6. [PMID: 17688028 DOI: 10.2298/aci0604021c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Equinus deformity of the foot presents a great number of difficulties to ambulant patients with cerebral palsy. Non-operative treatment of the incorrectible - fixed equinus is not successful. Many procedures are applied to treat it operatively, so its not clear which procedure at what age is the most successful. The purpose of this manuscript. is to clarify the issue. The results of four procedures are analyzed: aponeurectomny of m. gastrocnemius, Achilles tendon lengthening by z-plasty, a combination of these two procedures and sliding elongation of m. triceps surae. The analysis was based on 417 operations in 291 patients of the average age of 9 years (1-64). The average followup was 7 years. The assesment of the results was based on the visual evaluation of the gait, on pedoscope prints and on comparison of ankle movements before and after operation. The analysis shows that the best results were achieved by sliding elongation of m. triceps surae after the age of 7.
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Affiliation(s)
- G Cobeljić
- Institut za ortopedsko-hirurske bolesti Banjica Beogtrad
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21
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Abstract
Toe flexor tightness becomes apparent in the plantigrade attitude achieved by isolated tendoachilles lengthening in cerebral palsy. This frequently persists, resulting in abnormal weight-bearing on the tips of the toes. To address this problem, at the time of limited tendoachilles lengthening, we performed Z-lengthenings of the flexor hallucis longus and the flexor digitorum longus tendons above the medial malleolus, preserving the pulley mechanism. From January 1998 to October 2001, 41 children (74 feet) with cerebral palsy underwent lengthening of the tendoachilles and long toe flexor tendons. The mean age at surgery was 7 years. The correction achieved was successfully maintained long-term, permitting a normal heel-metatarsal head weight-bearing pattern. Lengthening of the long toe flexors, in conjuction with tendoachilles lengthening, is an effective means of achieving a balanced foot in cerebral palsy.
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Affiliation(s)
- John E Handelsman
- Division of Pediatric Orthopaedic Surgery, Schneider Children's Hospital, New Hyde Park, New York, USA.
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Biedermann R, Kaufmann G, Lair J, Bach C, Wachter R, Donnan L. High recurrence after calf lengthening with the Ilizarov apparatus for treatment of spastic equinus foot deformity. J Pediatr Orthop B 2007; 16:125-8. [PMID: 17273040 DOI: 10.1097/bpb.0b013e32801092d9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Both gastrocnemius recession and Achilles tendon lengthening lead to scarring in the calf and have high reported recurrence rates when performed under the age of 8 years. Triceps surae lengthening by external fixation seemed to be a valuable alternative. Twelve calf lengthenings have been performed with an Ilizarov device with a mean correction of 27 degrees. No calcaneal gait was observed, but there was a slow continuous loss of dorsiflexion over the observation period. The Ilizarov technique has a higher recurrence rate than most operative procedures for calf lengthening, but carries virtually no risk in producing calcaneus. The technique cannot be recommended for routine clinical use and may only be an alternative for selected cases.
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Affiliation(s)
- Rainer Biedermann
- Department of Orthopaedics, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Manganotti P, Zaina F, Falso M, Milanese F, Fiaschi A. Evaluation of botulinum toxin therapy of spastic equinus in paediatric patients with cerebral palsy. J Rehabil Med 2007; 39:115-20. [PMID: 17351692 DOI: 10.2340/16501977-0036] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To develop a clinical and instrumental protocol to assess the postural and dynamic effects following treatment with botulinum neurotoxin A in children with cerebral palsy affected by spastic equinus. DESIGN Open study, in which every patient served as his or her own control. PATIENTS Ten sequential children with cerebral palsy and spastic dynamic equinus foot. METHODS Botulinum neurotoxin A was injected in the gastrocnemius, soleus and tibialis posterior muscles. The main measures were: pedobarometry, dynamic surface electromyography, video gait analysis scale, and the modified Ashworth Scale. RESULTS After treatment with botulinum neurotoxin A, pedobarometric evaluation revealed a significant change in all parameters, including a decrease in the modified Ashworth Scale and an increase in the range of motion. All children showed significant improvement in initial foot contact, as documented by the video gait analysis scale. The calf muscle electromyography pattern showed a decrease in co-contraction during gait in all children. These modifications were statistically significant for all parameters considered (p < 0.05). CONCLUSION This pilot study suggests that dynamic electromyography and pedobarometry are simple to use and provide useful data; this protocol could be preferable in young and uncooperative children in order to monitor rehabilitation treatments.
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Affiliation(s)
- Paolo Manganotti
- Department of Neurological Sciences and Vision Neurological Rehabilitation Section, Policlinico GB Rossi, Piazzale Scuro 10, University of Verona, Verona, Italy.
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Massaad F, van den Hecke A, Renders A, Detrembleur C. Influence of equinus treatments on the vertical displacement of the body's centre of mass in children with cerebral palsy. Dev Med Child Neurol 2006; 48:813-8. [PMID: 16978460 DOI: 10.1017/s0012162206001757] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2006] [Indexed: 11/06/2022]
Abstract
We assessed the influence of equinus gait treatments on the vertical displacement of the body's centre of mass (COM) in 21 patients with cerebral palsy (14 males, 7 females; mean age 8 y 9 mo [SD 2 y]; range 3 y 7 mo-17 y) presenting different topographical types (quadriplegia, n = 1; diplegia, n = 6; right hemiplegia, n = 6; and left hemiplegia, n = 8). Vertical COM displacement was computed from ground reaction forces, and lower limb kinematics was recorded simultaneously. Equinus gait was treated with non-operative treatments (i.e. botulinum toxin injections and stretching casts) in 14 patients, and with operative treatments in seven patients. After non-operative treatments, the entire ankle displacement shifted towards dorsiflexion throughout the gait cycle, but the amplitude of the third foot rocker (TR) and vertical COM displacement remained unchanged. However, after operative treatments, the amplitude of TR increased and vertical COM displacement decreased. A negative linear correlation was found between the former variables in all the patients where 53% of the changes in their vertical COM displacement, after equinus gait treatments, were explained by the changes in TR amplitude. In fact, TR remains a main gait determinant, reducing the vertical COM displacement after equinus gait treatment and influencing the general gait pattern.
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Affiliation(s)
- Firas Massaad
- Rehabilitation and Physical Medicine Unit, Université catholique de Louvain, Brussels, Belgium.
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Abstract
OBJECTIVE To assess the kinetic and kinematic characteristics of hemiplegic stroke patients' gait initiation patterns during the various gait initiation phases. DESIGN AND SUBJECTS Gait initiation was studied in 3 hemiplegic subjects with a spastic equinus varus foot and 3 control subjects. METHODS Temporal and kinetic analysis of gait initiation was performed with 2 AMTI force plates, and kinematic analysis of gait initiation with an ELITE optoelectronic system. A one-way ANOVA was performed directly on the phase durations, forces, centre of pressure displacements, stride length, and ankle motion range. RESULTS Duration of the monopodal phase was shorter in hemiplegic patients when the affected leg rather than the sound one was used as the supporting leg. Propulsion forces were exerted by the hemiplegic patients' sound leg during the postural phase. Hemiplegic patients' body weight was supported more by the sound leg than by the affected leg. Knee was lifted higher on the affected side during the swing phase to compensate for the equinus. Initial contact was performed with a flat foot on the affected side. CONCLUSION Quantitative data obtained on the gait initiation phase suggest that hemiplegic patients develop asymmetrical adaptive posturo-motor strategies to compensate for their impairments.
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Affiliation(s)
- Laurent Bensoussan
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of the Mediterranean, Public Hospital System of Marseilles, University Hospital la Timone, Marseilles, France.
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Abstract
OBJECTIVE To determine whether fascicular neurotomy has long-lasting effects on spasticity. DESIGN We present 4 clinical cases and a critical analysis of the literature. PATIENTS This is a retrospective study on 4 patients referred to our department for spastic equinovarus foot deformity. For all 4, neurotomy was successful not long after surgery, but spasticity reappeared after a few months. METHODS We compared our results with those in the PubMed database. RESULTS Most publications acknowledge the immediate effectiveness of this surgery, but do not study the long-term effects of neurotomy. No publication proved long-lasting effects of neurotomy for spastic equinovarus foot deformity. The only long-term follow-up with a sufficient population is the one of Berard et al. who reported 61% recurrence. CONCLUSION There is no study showing that tibial nerve neurotomy has long-lasting effects. The 4 cases reported are an illustration that recurrence of spasticity may occur after neurotomy. These findings have to be taken into account for treatment decision-making and for provision of information to patients.
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Affiliation(s)
- Hervé Collado
- Department of Physical and Rehabilitation Medicine, Faculté de Médecine, Université de la Méditerranée, Assistance Publique Hopitaux de Marseille, University Hospital La Timone, Marseille, France.
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Qin SH, Sun L, Zheng XJ. [Mini-invasive distraction technique for treatment of severe ankle and foot deformities secondary to ischemic contracture of the leg]. Zhonghua Wai Ke Za Zhi 2006; 44:547-50. [PMID: 16784635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To explore the Ilizarov mini-invasive distraction technique for the treatment of severer ankle and foot deformities secondary to ischemic contracture of the leg. METHODS Based on the tension-stress low of Ilizarov, a serial of adjustable three dimensions external distractive instrument was developed in our department. From April 2002 to March 2004, 8 patients with ankle and foot deformities secondary to ischemic contracture of the leg induced by trauma and fracture were treated with the distractive instrument. Of them, 4 patient were male and 4 female, aged from 13 to 31 years with an average of 23 years. Five affected legs were in the left and 3 in the right. Preoperative abnormal style included talipes equines in 6 feet and equinovarus in 2 feet, with extensive scar contracture in the legs. Five patients suffered from failure of soft tissue release before, two patients with severe bony deformity of the feet were underwent limited foot triple osteotomy in this department before the distractive correction. The distraction was begun from 7 d after operation and distractive time from 29 to 60 d with an average 46 d. RESULTS All of the 8 patients were followed up from 10 months to 29 months, with an average of 13 months. All of deformities in the feet were corrected satisfactorily, full feet contacted with the ground in stand or walking and achieved with good function. No complication, such as pin tract infection, skin necrosis and neurovascular injury was occurred in this group. CONCLUSIONS Mini-invasive distraction technique for treatment of severe ankle and foot deformity secondary to ischemic contracture of the leg is safe and mini-injury, it is also an effective approach for the treatment of various kinds of rigid foot anomaly.
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Affiliation(s)
- Si-he Qin
- Department of Orthopaedics, Beijing Chaoyang District Orthopaedics Hospital, Beijing 100024, China.
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Orendurff MS, Rohr ES, Sangeorzan BJ, Weaver K, Czerniecki JM. An equinus deformity of the ankle accounts for only a small amount of the increased forefoot plantar pressure in patients with diabetes. ACTA ACUST UNITED AC 2006; 88:65-8. [PMID: 16365123 DOI: 10.1302/0301-620x.88b1.16807] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients with diabetes mellitus may develop plantar flexion contractures (equinus) which may increase forefoot pressure during walking. In order to determine the relationship between equinus and forefoot pressure, we measured forefoot pressure during walking in 27 adult diabetics with a mean age of 66.3 years (sd 7.4) and a mean duration of the condition of 13.4 years (sd 12.6) using an Emed mat. Maximum dorsiflexion of the ankle was determined using a custom device which an examiner used to apply a dorsiflexing torque of 10 Nm (sd 1) for five seconds. Simple linear regression showed that the relationship between equinus and peak forefoot pressure was significant (p < 0.0471), but that only a small portion of the variance was accounted for (R(2) = 0.149). This indicates that equinus has only a limited role in causing high forefoot pressure. Our findings suggest caution in undertaking of tendon-lengthening procedures to reduce peak forefoot plantar pressures in diabetic subjects until clearer indications are established.
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Affiliation(s)
- M S Orendurff
- Department of Orthopaedics and Sports Medicine, VA Puget Sound Health Care System, University of Washington, MS 151, 1660 South Columbian Way, Seattle, WA 98108, USA.
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Wallny T, Brackmann H, Kraft C, Nicolay C, Pennekamp P. Achilles tendon lengthening for ankle equinus deformity in hemophiliacs: 23 patients followed for 1-24 years. Acta Orthop 2006; 77:164-8. [PMID: 16534718 DOI: 10.1080/17453670610045867] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Bleeding in the calf or ankle joint may lead to ankle equinus deformity, particularly in childhood and during adolescence. We assessed the long-term functional and radiographic results after Achilles tendon lengthening for ankle equinus deformity in hemophiliacs. PATIENTS AND METHODS Between 1975 and 1986, 30 hemophilic patients with pes equinus were surgically managed by Achilles tendon lengthening. Of these, 23 were followed up prospectively twice a year for an average of 13 (1-24) years. The mean age at operation was 29 (12-46) years. The clinical results were documented according to the score of the Advisory Committee of the World Federation of Hemophilia (WFH), while radio-graphs were evaluated using the Pettersson score. On average, preoperative ankle equinus deformity was 21 (5-55) degrees. Mean range of motion was 21 (5-42) degrees prior to surgery. RESULTS At the first postoperative examination 1 year after surgery, 21/23 cases were improved, and 9/21 reached dorsiflexion to at least neutral position. At the last follow-up, ankle equinus deformity was 10 (4-20) degrees on average. 20/23 patients still showed significant improvement compared to their condition before surgery. 7 patients still had complete correction of the equinus deformity, while mean range of motion decreased constantly over the observation period. The clinical score was significantly improved 1 year after surgery and diminished only slightly afterwards. Radio-graphic outcome deteriorated, with scores rising from 4.3 (1-10) points preoperatively to 7.3 (3-12) points at last follow-up. INTERPRETATION Most patients treated for hemophilic pes equinus by Achilles tendon lengthening experienced long-term benefit concerning the equinus deformity, but gradually lost overall movement of the ankle joint. Progression of the ankle arthropathy cannot be hindered.
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Affiliation(s)
- Thomas Wallny
- Department of Orthopedic Surgery, University of Bonn, Germany.
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Abstract
Equinus contracture often is a complication of trauma, burns, or neurologic deficit. Many patients with contractures secondary to trauma or burns have poor soft tissue, which makes invasive correction a less appealing option. The Ilizarov external fixator has been used as a less invasive attempt to correct equinus contracture. We describe our "dynamic" technique and present a clinical patient series using a variation of the unconstrained Ilizarov technique, which uses elastic bands rather than threaded rods to supply the corrective force.
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Affiliation(s)
- J Stuart Melvin
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Cardoso ES, Rodrigues BM, Barroso M, Menezes CJ, Lucena RS, Nora DB, Melo A. Botulinum toxin type A for the treatment of the spastic equinus foot in cerebral palsy. Pediatr Neurol 2006; 34:106-9. [PMID: 16458821 DOI: 10.1016/j.pediatrneurol.2005.08.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Revised: 05/18/2005] [Accepted: 08/11/2005] [Indexed: 11/29/2022]
Abstract
Muscle overactivity, one of the cardinal features of spasticity, is a common sequel of cerebral palsy. In this group of patients spasticity is responsible for several limitations that interfere with gait, causing variable functional disability. Drugs such as baclofen, tizanidine, or benzodiazepines, or even definitive treatments such as orthopedics or neurosurgeries are generally prescribed with uncertain results. The use of botulinum toxin type A has been frequently suggested for the treatment of spastic equinus foot in cerebral palsy, but few studies with adequate methodology support this idea. The present paper reviews and summarizes the data of published double-blind, randomized clinical trials to assess, with a meta-analysis, if botulinum toxin type A is an adequate treatment for spasticity caused by cerebral palsy. The results reveal a statistical superiority of botulinum toxin type A over placebo on gait improvement, tested using the Physician Rating Scale and Video Gait Analysis (Peto odds ratio = 3.99, 95% confidence interval = 2.20-7.22) in patients with spastic equinus foot. The botulinum toxin group also presented better results in the subjective assessment than the placebo group (Peto odds ratio = 3.49, 95% confidence interval = 1.50-8.12). Adverse events were more frequently observed after the use of botulinum toxin type A, but they were considered mild and self-limited.
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Affiliation(s)
- Eduardo S Cardoso
- Neurology and Epidemiology Division, Federal University of Bahia, Salvador-Bahia, Brazil
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Alcantud JF, Ruiz M, Planas A, Vázquez M, Hernández J, Riquelme I. [Unilateral compartment syndrome secondary to prolonged lithotomy positioning and peripheral vascular disease]. Rev Esp Anestesiol Reanim 2006; 53:61-2. [PMID: 16475646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Dietz FR, Albright JC, Dolan L. Medium-term follow-up of Achilles tendon lengthening in the treatment of ankle equinus in cerebral palsy. Iowa Orthop J 2006; 26:27-32. [PMID: 16789444 PMCID: PMC1888588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION The optimal treatment for equinus of the ankle in ambulatory patients with cerebral palsy is not known. This study assessed the medium term follow-up results of treatment of spastic ankle equinus deformity in cerebral palsy using Hoke or coronal Z-lengthening of the Achilles tendon. It was hypothesized that the use of Achilles tendon lengthening (TAL) as a treatment for spastic ankle equinus during gait results in a high rate of over-weakening of the triceps surae resulting in crouch gait. We also investigated patient characteristics that could identify which patients are at risk for crouch gait due to triceps surae weakening from Achilles tendon lengthening. MATERIALS AND METHODS Seventy-nine patients (114 procedures) who had undergone Achilles lengthening were retrospectively reviewed to determine how many patients developed crouch gait with dorsiflexion of the ankle throughout stance phase requiring anterior-floor-reaction bracing. The following patient characteristics were evaluated: age at surgery, geographic type of cerebral palsy, length of follow-up, need for anterior-floor-reaction bracing, length of time after surgery when brace was prescribed, age at time of need for bracing, side of surgery, technique used, additional procedures performed at time of TAL, previous or later procedures performed, and walking ability. RESULTS The average age at the time of TAL was 7 years and 3 months, and the average follow-up was seven years. The geographic type of cerebral palsy greatly affected the outcome. None of the twenty-three hemiplegic patients required bracing. Fourteen of 34 (41%) patients with spastic diplegia and seven of fourteen (50%) patients with spastic quadriplegia required bracing. There was no significant difference in outcome between the Hoke and the Z-lengthening procedures. Patients who underwent more procedures and bilateral procedures were more likely to require anterior-floor-reaction bracing. CONCLUSIONS Achilles tendon lengthening as practiced by the senior author results in a high rate of over weakening of the triceps surae as defined by the need for a floor reaction brace. Results are best in patients with hemiplegia and non-hemiplegic patients who require only single leg surgery, and who do not require concomitant or subsequent surgery. Alternative treatment, such as gastrocnemius fascial lengthening, or non-surgical treatment may be the optimal treatment of ambulatory patients with spastic diplegia and quadriplegia who have spastic ankle equinus during gait.
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Affiliation(s)
- Frederick R Dietz
- Department of Orthopaedics Surgery, University of Iowa Hospitals and Clinics Iowa City, IA 52242, USA.
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Takehana K, Kawaguchi Y, Kuroda K, Yamazaki M, Kimura T. Transient talipes equinus deformity of bilateral lower limbs following malignant hyperthermia: a case report and review of literature. J Orthop Sci 2005; 9:657-61. [PMID: 16228690 DOI: 10.1007/s00776-004-0843-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2004] [Accepted: 08/20/2004] [Indexed: 10/26/2022]
Abstract
Malignant hyperthermia (MH) is a potentially fatal disease triggered by general anaesthesia. Four cases of compartment syndrome complicating MH have been reported. We report here a case of transient talipes equinus deformity of bilateral lower limbs, a condition similar to compartment syndrome, following MH in a previously healthy pediatric patient. MRI revealed high intensity in the bilateral soleus muscles but not in the gastrocnemius muscles. We discuss the possible mechanisms of the deformity of the lower limbs after the MH crisis.
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Abstract
The purpose of this study was to determine recurrence rates of pediatric foot and ankle burn deformities treated with the Ilizarov method. A total of 19 patients with 29 foot and ankle deformities were studied. The most common deformity treated was equinus (23). Rocker-bottom and cavus foot deformities were each treated three times. The average age of the patient at the time of the burn injury was 3.2 years, and the average age at the time of fixation was 9.4 years. Equinus contractures averaged -34 degrees (34 degrees of plantarflexion) before surgery and +7 degrees (7 degrees of dorsiflexion) after treatment with the Ilizarov fixator. The recurrence rate for all 29 ankles and feet was 69% (20/29). The recurrence rate for equinus contractures was 74% (17/23). The average time to recurrence was 17.3 months. Only short-term follow-up was available on four of the six feet and ankles that did not recur. Deformity correction in burned feet and ankles is difficult to obtain by any means. The authors recommend using the Ilizarov method to obtain correction of moderate to severe foot and ankle deformities in pediatric burn patients, but the correction obtained is not stable and deformity will likely recur. Parents and patients should anticipate adjunctive nonoperative and operative procedures to keep their feet plantigrade as they grow. In young children, the possibility of having additional surgeries, including repeat Ilizarov procedures, should be discussed. Even older children should expect additional surgeries to prevent recurrent deformities.
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Affiliation(s)
- Kelly D Carmichael
- Department of Orthopaedics and Rehabilitation, University of Texas Medical Branch, Galveston, Texas 77555-0353, USA.
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Morelet A, Gagneux-Lemoussu L, Brochot P, Ackah-Miezan S, Colmet-Daage JF, Gaillard F, Boyer F, Eschard JP, Etienne JC. Tonic dystonia: an uncommon complication of reflex sympathetic dystrophy syndrome. A review of five cases. Joint Bone Spine 2005; 72:260-2. [PMID: 15850999 DOI: 10.1016/j.jbspin.2005.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2003] [Accepted: 01/07/2005] [Indexed: 11/18/2022]
Abstract
Tonic dystonia is an underrecognized complication of reflex sympathetic dystrophy syndrome (RSDS) characterized by an increase in muscle tone at the site of injury. Case-reports.- We describe five cases of tonic dystonia complicating RSDS of the lower extremity. There were four women and one man, with a mean age of 52 years. In addition to the typical features of RSDS, the patients had fixed equinovarus of the foot with hyperextension or hyperflexion of the great toe. In two patients, examination after spinal anesthesia showed that the deformity was reducible. Spontaneous resolution of the dystonia occurred in one patient. Another patient failed to experience meaningful improvement after a motor block followed by botulinic toxin injections. In two patients, the same treatment was followed by a slight improvement. Treatment options are still being evaluated in the last patient. Discussion.- Tonic dystonia is an underrecognized complication of RSDS that often develops after a minor injury yet causes prolonged pain and disability. Spread of the dystonia to other sites is not infrequent. The underlying mechanisms remain unclear but may involve dysfunction of the central or peripheral nervous system or psychogenic factors. Suggested treatments include motor block, intrathecal baclofen, sympathetic block, and sympathectomy. However, none of these treatments has been proved effective. Conclusion.- The five cases described here provide useful information on RSDS-associated tonic dystonia, a condition that runs a protracted course and remains difficult to manage.
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Affiliation(s)
- Aude Morelet
- Rheumatology Department, Sébastopol Teaching Hospital, 51100 Reims, France.
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Delatycki MB, Holian A, Corben L, Rawicki HB, Blackburn C, Hoare B, Toy M, Churchyard A. Surgery for equinovarus deformity in Friedreich's ataxia improves mobility and independence. Clin Orthop Relat Res 2005:138-41. [PMID: 15662315 DOI: 10.1097/01.blo.0000150339.74041.0e] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Friedreich's ataxia results in morbidity because of many factors; progressive equinovarus deformity is one of these. We studied the risk factors and incidence of this deformity. We sought to assess whether surgical management of fixed equinovarus deformity leads to functional improvement. Thirty-six patients with Friedrich's ataxia were assessed for this deformity. These patients were treated by splinting, botulinum toxin Type A injection, and surgery, as indicated by the severity, followed by an ongoing rehabilitation program. The effect of surgery was assessed using subscales of the Barthel index and functional independence measure. Severe foot deformities in which either surgery or botulinum toxin injection was recommended correlated with current age, years since disease onset, and years that the patient required a wheelchair for mobility, but not with the GAA repeat size or age at disease onset. Function and mobility were improved after surgery compared with a similar period before surgery. Three of seven patients who had surgery had significant complications. Aggressive management of foot deformities should be considered, and active measures to prevent permanent foot deformities should be pursued to maximize quality of life and independence of patients with Friedreich's ataxia. LEVEL OF EVIDENCE Therapeutic study, Level IV (case series-no, or historical control group).
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Affiliation(s)
- Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Genetic Health Services Victoria, Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, Australia.
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Wren TAL, Do KP, Kay RM. Gastrocnemius and soleus lengths in cerebral palsy equinus gait—differences between children with and without static contracture and effects of gastrocnemius recession. J Biomech 2004; 37:1321-7. [PMID: 15275839 DOI: 10.1016/j.jbiomech.2003.12.035] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2003] [Indexed: 11/27/2022]
Abstract
Equinus gait is one of the most common abnormalities in children with cerebral palsy. Although it is generally assumed that the calf muscles are abnormally short in equinus gait, no studies have been done to confirm that the muscles are short and that this shortness contributes to the equinus. This study used musculoskeletal modeling combined with computerized gait analysis to examine medial gastrocnemius (MGAS), lateral gastrocnemius (LGAS), and soleus (SOL) musculotendinous lengths during equinus gait in children with cerebral palsy. All three muscles were abnormally short during equinus gait whether or not the children had equinus contractures (P < or = 0.005). Children with static contractures had shorter maximum static MGAS and LGAS lengths than children with dynamic equinus (P < or = 0.002). The children with static contractures had ratios of peak dynamic length to maximum static length close to 1.0 for MGAS and LGAS (1.005 +/- 0.015) but lower ratios for SOL (0.984 +/- 0.024). For the children with static contracture, these ratios did not change significantly after gastrocnemius recession (P > or = 0.14) because both static and dynamic lengths increased postoperatively (P < or = 0.04). These results support the current clinical understanding of the role of calf "tightness" in equinus gait, including the appropriateness and effectiveness of gastrocnemius recession for children with equinus contracture.
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Affiliation(s)
- Tishya A L Wren
- Childrens Orthopaedic Center, Childrens Hospital Los Angeles, 4650 Sunset Blvd., No. 69, Los Angeles, CA 90027, USA.
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Abstract
Of 23 children (35 feet) with cerebral palsy who had undergone a Grice extra-articular subtalar arthrodesis for a valgus hindfoot between 1976 and 1981, we reviewed 17 (26 feet), at a mean of 20 years (17 years 3 months to 22 years 4 months) after operation. Seven were quadriplegic, eight spastic diplegic, and two hemiplegic. They were all able to walk at the time of operation. Thirteen patients (20 feet) were pleased with the Grice procedure, 13 had no pain and 15 (23 feet) were still able to walk. The clinical results were satisfactory for most feet. Radiography showed that the results had been maintained over time but 14 feet developed a mean ankle valgus of 11° (6 to 18) with a compensatory hindfoot varus in 12 feet. No deformity of the talus or arthritis of adjacent joints was noted. The Grice procedure gives good long-term results in children with cerebral palsy.
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Affiliation(s)
- S Bourelle
- Medical School of Medicine, Saint-Etienne, France
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Abstract
Soft tissue venous malformations of muscles may produce musculoskeletal deformities caused by contracture of the involved muscle. When the venous malformation involves the flexor muscles of the leg, equinus deformity and toe-walking may occur. Three patients with unilateral toe-walking secondary to venous malformation of the calf muscle, showing the classic presentation of this unusual condition, are presented. Several methods of treating the deformity and the underlying venous malformation are discussed, and the current literature on intramuscular venous malformations, including their natural history, diagnoses, treatment options, and outcomes, is reviewed. Based on our experience and review of the literature, percutaneous sclerotherapy may be a viable option for treatment of venous malformations of the calf musculature that result in a toe-walking deformity.
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Affiliation(s)
- Benjamin G Domb
- Department of Orthopaedic Surgery, The Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224-2780, USA
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Verdié C, Daviet JC, Borie MJ, Popielarz S, Munoz M, Salle JY, Rebeyrotte I, Dudognon P. Épidémiologie des pieds varus et/ou équin un an après un premier accident vasculaire cérébral hémisphérique : à propos d'une cohorte de 86 patients. ACTA ACUST UNITED AC 2004; 47:81-6. [PMID: 15013602 DOI: 10.1016/j.annrmp.2003.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2003] [Accepted: 10/20/2003] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the frequency and the functional consequences of varus equinus in stabilized vascular hemiplegia. METHODS Prospective cohort study of 86 hemiplegic patients. All patients consecutively admitted for a first hemispheral stroke between July 2001 and January 2002 were included. The evaluation consisted in a clinical examination and a descriptive study of gait. The functional capacity of patients with and without varus equinus were compared using the Barthel index, the New Functional Ambulation Classification (NFAC), the confortable ten meters gait speed and gait perimeter. RESULTS The incidence of varus equinus was 18%. There was no difference in gait speed (0.8 m/s), NFAC or Barthel index between patients with or without varus equinus. Patients with varus equinus had had more specialized, intensive and prolonged rehabilitation. The only prognostic factor that could be identified was the motor impairment and the existence of spasticity. DISCUSSION The mechanism of varus equinus is thought to be mainly the over-activity of gastrocnemius and solaris compared to that of the tibialis anterior, associated to the weakness of fibular muscles. The role of tibialis posterior is thought to be less important. The frequency of varus equinus after a first hemispheral stroke was low and the consequences were limited. This could be in part explained by the access of these patients to early, specialized and prolonged rehabilitation care.
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Affiliation(s)
- C Verdié
- Département de médecine physique et de réadaptation, hôpital Jean-Rebeyrol, CHU Dupuytren, 87042 Limoges, France
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Affiliation(s)
- J-M Mazaux
- Groupe handicap et cognition, EA 487, université Victor-Segalen-Bordeaux-II, 33076 Bordeaux cedex, France.
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Abstract
An orthosis developed in Dokuz Eylül University (DEU) at the School of Physical Therapy and Rehabilitation, Department of Orthotics and Prostheticsis is described. It is applied as a non-invasive device attached to the distal ring of the Ilizarov external fixator to keep the ankle joint in a neutral position and prevent ankle equinus during tibial lengthening with Ilizarov technique. This minimises additional invasive techniques such as heel cord release and prophylactic pinning of the heel and the foot, and manipulation under anaesthesia. It may also be detached by the physiotherapist or patient when physical therapy is needed during the lengthening procedure.
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Affiliation(s)
- S Angin
- School of Physical Therapy and Rehabilitation, Department of Orthotics and Prosthetics, Dokuz Eylül University, Inciralti, Izmir, Turkey.
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Abstract
Melorheostosis often is disabling because of progressive contracture of the joint and soft tissue involved. Operative intervention often is hazardous and patients also have recurrences. A 14-year, 2-month-old boy, who presented with a recurrent equinoplanovalgus deformity of the right foot caused by melorheostosis, was treated successfully using the Ilizarov technique, including distraction osteotomy in the calcaneus. The patient had a painless, plantigrade, and functional foot at age 18 years.
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Affiliation(s)
- In Ho Choi
- Department of Orthopedic Surgery, Seoul National University Children's Hospital and Clinical Research Institute, Chongnogu, Korea.
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Pittock SJ, Moore AP, Hardiman O, Ehler E, Kovac M, Bojakowski J, Al Khawaja I, Brozman M, Kanovský P, Skorometz A, Slawek J, Reichel G, Stenner A, Timerbaeva S, Stelmasiak Z, Zifko UA, Bhakta B, Coxon E. A double-blind randomised placebo-controlled evaluation of three doses of botulinum toxin type A (Dysport) in the treatment of spastic equinovarus deformity after stroke. Cerebrovasc Dis 2003; 15:289-300. [PMID: 12686794 DOI: 10.1159/000069495] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2002] [Accepted: 08/13/2002] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND/OBJECTIVES Calf muscle hypertonicity following stroke may impair walking rehabilitation. The aim of this study was to assess botulinum toxin (Dysport) in post-stroke calf spasticity. METHODS A prospective, multicentre, double-blind, placebo-controlled, dose-ranging study was performed to evaluate dysport at 500, 1,000 or 1,500 units in 234 stroke patients. They were assessed at 4-week intervals over 12 weeks. RESULTS The primary outcome measure, 2-min walking distance and stepping rate increased significantly in each group (p < 0.05, paired test), but there was no significant difference between groups (including placebo). Following dysport treatment, there were small but significant (p = 0.0002-0.0188) improvements in calf spasticity, limb pain, and a reduction in the use of walking aids, compared to placebo. Investigators' and patients' assessments of overall benefit suggested an advantage for dysport over placebo, but this was not significant. Sixty-eight patients reported 130 adverse events, with similar numbers in each group. The few severe events recorded were not considered to be treatment-related. CONCLUSION Dysport resulted in a significant reduction in muscle tone, limb pain and dependence on walking aids. The greatest benefits were in patients receiving dysport 1,500 units, but 1,000 units also had significant effects. Dysport 500 units resulted in some improvements. Since few adverse events were reported, this therapy is considered safe and may be a useful treatment in post-stroke rehabilitation of the leg. Possible reasons why functional improvements in gait parameters were not observed are also discussed.
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Affiliation(s)
- S J Pittock
- Department of Neurology, Beaumont Hospital, Dublin, Ireland.
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Koman LA, Smith BP, Barron R. Recurrence of equinus foot deformity in cerebral palsy patients following surgery: a review. J South Orthop Assoc 2003; 12:125-33, quiz 134. [PMID: 14577719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Although equinus deformity in children with cerebral palsy is often corrected with surgery, postsurgical recurrence of the deformity is not uncommon. In order to isolate factors that may be related to its recurrence, 31 studies were evaluated. Data from nine articles indicated that children younger than approximately 7 years of age at the time of surgery had a higher risk of recurrence than children who were older at the time of surgery. Recurrence rates may be understated in studies including less than a minimum of 4-5 years of patient follow-up. Lower recurrence rates are documented in diplegic patients compared with hemiplegic patients, and postoperative casting/splinting is stated, but not documented, to reduce recurrence. One study demonstrated that the use of chemodenervation delayed surgery and by inference theoretically would decrease recurrence after surgical release.
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Affiliation(s)
- L Andrew Koman
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070, USA
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Poul J, Pesl M, Pokorná M. [Percutaneous aponeurotomy of the triceps surae muscle in cerebral palsy in children]. Acta Chir Orthop Traumatol Cech 2003; 70:292-5. [PMID: 14669591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
PURPOSE OF THE STUDY To assess the short-term results of percutaneous aponeurotomy of gastrocnemius including the possible complications and effects of the treatment. MATERIAL Totally 88 procedures were performed in 61 patients in the period 1998-2001. Re-examination in 2002 involved 44 patients with 66 procedures. METHODS The procedure was done from one-point incision. Six weeks immobilisation followed. Re-examination concerned the shape of the calf, the testing for palpable defect, US examination of calf muscles and aponeurosis, neurological and vascular examination. RESULTS Recurrence of mild degree of equinus deformity was found in 3 out from 66 procedures. No neurological or vascular complications were registered. DISCUSSION Rate of recurrence in this study is comparable with the figures after open aponeurotomy. CONCLUSION Operation is reserved for skilled surgeon, however in short future, most of operations on spastics will be done like video-assisted procedures.
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Affiliation(s)
- J Poul
- Klinika dĕtské chirurgie, ortopedie a traumatologie, Dĕtská nemocnice, FN Brno.
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Atesalp AS, Yildiz C, Kömürcü M, Basbozkurt M, Gür E. Posterior tibial tendon transfer and tendo-Achilles lengthening for equinovarus foot deformity due to severe crush injury. Foot Ankle Int 2002; 23:1103-6. [PMID: 12503800 DOI: 10.1177/107110070202301204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Surgical correction was performed on nine patients who had equinovarus deformity caused by severe crush injury of the leg sustained in an earthquake. The operative procedure used involved the transfer of the posterior tibial tendon to the dorsum of the foot by passing it through the interosseous membrane using a modified procedure as published in 1978. This procedure was combined with percutaneous Achilles tendon lengthening and tenotomy of toe flexors when needed. The average follow-up time after the operation was 21 months. The treatment improved the heel-toe steppage gait in all patients and all were able to walk in standard shoes. There were no complications in the postoperative period. Recurrence of varus deformity was not seen in any of the patients. They had active dorsiflexion of the foot, with a median active dorsiflexion of 5 degrees (0 to 10 degrees) and median active plantarflexion of 16.1 degrees (10 to 25 degrees) compared to the median active dorsiflexion and plantarflexion on the uninvolved side. The total range-of-motion was 21.1 degrees (10 to 35 degrees).
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Affiliation(s)
- Ali Sabri Atesalp
- Gülhane Military Medical Academy and Faculty, Department of Orthopedic Surgery and Traumatology, 06018, Etlik, Ankara, Turkey.
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