60. The role of neurophysiology in the diagnosis of incorrect foot support in childhood: Who hides a neurological disease?

Abstract

The “orthopedic alteration” of foot in the child may underlie neurological disorders that may be underestimated. The aim of this study is to demonstrate the important role of neurophysiological tests for the identification of the source on the pathological foot support incorrect in children. We studied 71 subjects (33 females) with incorrect foot support with a defined neurophysiological protocol that includes the ENG (at least 3 nerves), EMG and Muscular Ultrasound (at least two muscles) studies; Motor Evoked Potentials (from Tibialis Anterior muscles) and Somatosensory Evoked Potentials (from Tibialis posterior nerves). Of the 71 patients 31 subjects showed equinus foot, 16 prone foot, 13 pes cavus, 4 spurious valgus, 3 clubfoot, 21 had not specific incorrect support. Neurophysiological tests have identified a neurological cause in about a third of patients (35%). Of this 35%: 48% had a hereditary neuropathy, 28% mono-multi-neuropathy, 8% myopathy, 8% cerebral palsy, 8% being defined. An appropriate neurophysiological protocol, largely executable by technical trained staff, allows the identification of neuro-muscular disorders underlying the incorrect foot support in children. This recognition enables a targeted treatment for these specific changes, assuming a close collaboration between orthopedic and neurologist.