Equinovarus Foot Deformity Research Articles

Short-term reduction of ankle spasticity after surgical lengthening of the triceps surae in chronic post-stroke patients: a retrospective cohort study.

In post-stroke patients with equinovarus foot deformity (EVFD), soft tissue rearrangements may contribute to muscle overactivity when a muscle is stretched or tension is applied. Therefore, we investigated the effects of surgically restoring the triceps surae (TS) length and lengthening ability on TS spasticity. This retrospective study included chronic post-stroke patients who underwent neuro-orthopedic surgery inclusive of TS lengthening. TS spasticity was measured using the Modified Tardieu Scale (MTS) before and 1 month after surgery, both with the knee extended (KE) and flexed (KF). MTS variations were analyzed using the Wilcoxon test. The time from stroke onset was compared between patients with and without post-surgical spasticity using the t-test. Statistical significance was set at 5%. A total of 120 patients with EVFD, aged 57 (12) years, ranging from 1 to 36 years from stroke, were included in the study. The median MTS_KE score significantly decreased from 3 (range 0-4) to 2 (0-4) (p < 0.001) after surgery. The MTS score decreased by ≥1 point in more than half of the sample. Notably, 19 and 32 patients were completely relieved from spasticity (MTS = 0) in the KE and KF conditions, respectively. Post-surgical spasticity did not depend on the time since stroke onset (p = 0.560). TS lengthening led to a short-term reduction of spasticity in 41% and 63% of chronic post-stroke patients in the gastro-soleus complex and soleus, respectively, with complete relief observed in 21% and 30% of the sample. Surgical lengthening can be considered an effective treatment that not only restores joint range of motion but also may reduce spasticity, even in chronic patients.

FEMORAL-FACIAL SYNDROME - A RARE CASE REPORT

Femoral-facial syndrome (FFS) is an extremely rare fetal malformation. It comprises bilateral femoral hypoplasia and craniofacial dysmorphism. Maternal diabetes is associated with approximately 40% of cases of FFS. We present the case of Femoral-Facial syndrome of Newborn female child. She was delivered by vaginal route at 36th week of gestation. Mother had a history of type 2 diabetes mellitus. She was having markedly shortened bilateral lower limbs, deformed hip joint and mild talipes equino-varus deformity of left foot. There was prominent forehead, short nose with broad tip, long philthrum, thin upper lip, micrognathism and malformed low set external ears. Skeletal radiograph shows complete absence of right femur and marked hypoplasia of left femur.

Long-term effects on body functions, activity and participation of hemiplegic patients in equino varus foot deformity surgical correction followed by immediate rehabilitation. A prospective observational study

ABSTRACTBackground: Functional surgery is an effective approach in the treatment of the rigid equinovarus foot deformity (EVFD). This must be associated with early rehabilitation treatments (ERTs) to prevent muscle rearrangements due to immobilization.Objectives: To assess the effects of EVFD surgical correction in adult stroke patients, when assessed according to the ICF domains.Methods: Variables from 24 adult chronic stroke survivors with EVFD surgical correction followed by ERT, age 55 ± 13 years, affected side 12L/12R, time from lesion 5 ± 4 years were analyzed. Body function domain: pain (NPRS), walking speed, clinical global impression of change (cGIC). Activity domain: Rivermead Mobility Index (RMI), FAC, and 6 min walking test (6MWT). Participation domain: Walking Handicap Scale (WHS). Patients were assessed before (T0), one (T1), three (T2) and twelve (T3) months after surgery by a single assessor.Results: All variables but the 6MWT significantly improved (Wilcoxon test, p < .05) at T1 or T2 and this remained until the 12-months mark. Since T1, all patients reached and maintained a supervised independent walking (FAC≥3) and all those wearing an AFO stopped using it. The median cGCI was “much improved” at T1, with a “further minimal improvement” at T3. This was not associated with the improvement measured by both FAC, and WHS (Chi-square test, p = .20 and p = .36, respectively).Conclusions: Functional surgery combined with ERT is effective in improving the patients’ condition according to all ICF domains. Both subjective and objective assessments have to be used when assessing these patients.

Safety and long-term effects on gait of hemiplegic patients in equinovarus foot deformity surgical correction followed by immediate rehabilitation: a prospective observational study.

Equinovarus foot deformity (EVFD) is the most common lower limb deformity in stroke patients. Immobilization following EVFD surgical correction is known to have a negative impact on muscle rearrangement with possible loss of walking ability in stroke patients. In a previous study, safe and positive effects at one-month follow-up after surgery were obtained with an early rehabilitation treatment (ERT) characterized by immediate walking and training. To determine long-term safety and efficacy of functional surgery followed by early rehabilitation (FSER). A 12 months prospective observational study. Outpatients clinic, Gait and Motion Laboratory, Sol et Salus Hospital, Rimini, Italy. Twenty-four adult chronic stroke survivors with EVFD surgical correction followed by ERT, age 55±13 years, affected side 12L/12R, time from lesion 5±4 years. Patients received clinical and instrumental evaluation by gait analysis (GA) before (T0), one, three and twelve months after surgery. Safety was defined as the absence of any complication consequent to FSER. Efficacy was assessed by the recovery in ankle kinematics, walking speed and space-time parameters. No clinical complication (thrombosis, surgical wound infection, muscle or tendon injury, muscle hematoma) arose in the sample during the follow-up year. Variables relating to ankle kinematics improved towards their normal values at one month after surgery. These were maintained at 3 and 12 months, with a significant difference between follow-ups and pre-surgical values (Durbin-Conover Test, P<0.01). Gait speed, cadence, anterior step length and stride length of the affected side showed a statistical improvement at 3 and 12 months (Wilcoxon test, P=0.012 and P=0.001, respectively). Stride width decreased at 1 month after surgery and showed a further stable reduction at 3 months (P=0.008). The ERT protocol with immediate rehabilitation starting on the first day after surgical correction was safe and effective in providing a long-term correction of EVFD. Ankle dorsiflexion improved both in stance and swing, allowing for a significative improvement in walking speed. FSER can be considered an encouraging approach in the management of EVFD, with durable results.

Tibiocalcaneal arthrodesis using intramedullary nail for severe rigid equinovarus deformity in adults

Aim: To evaluate the results of tibiocalcaneal arthrodesis using intramedullary nails in adults with severe rigid equinovarus deformity of foot. Background: Foot is an amazing structure of support, balance, locomotion and sensibility. Impairment of one or more of these functions can lead to catastrophic sequelae. Equinovarus deformities of foot can be very disabling by marring the ambulation, daily activities, shoe wear and hygiene. In this paper we tend to share our experience of treating patients with posttraumatic severe rigid equinovarus deformities via tibiocalcaneal arthrodesis with retrograde intramedullary nailing. Settings and Design: Prospective follow up study. Materials and Methods: We selected 10 patients (3 females, 7 males) aged 18–60 years, suffering from disabling non-braceable posttraumatic severe rigid equinovarus deformity of foot. The patients were treated via tibiocalcaneal arthrodesis with retrograde intramedullary nailing and functional outcome was evaluated by comparing the preoperative and postoperative Kitaoka Patzer ankle arthrodesis scores and Mazur ankle arthrodesis scores. Statistical Analysis Used: SPSS program for Windows, version 17.0 (SPSS, Chicago, Illinois). Result: The comparison of the preoperative and postoperative scores showed significant improvement from poor to good after tibiocalcaneal arthrodesis was done in such patients. Conclusion: We can conclude that tibiocalcaneal arthrodesis using intramedullary nails is a good option to provide a stable plantigrade foot to the patient though further improvements in implant designs may bring better options.

Effects of surgery and early rehabilitation treatment on equino-varus foot deformity (EVFD). Gait changes at one and three months after treatment assessed by a tri-axial accelerometer

s / Gait & Posture 42S (2015) S1–S90 S5 Table 1 Perturbed limb: mean angles and standard deviations for the step conditions S0, S1 and S2. Angle (◦) Healthy children Children with hemiplegia

Effects of surgery and early rehabilitation treatment (ERT) on equino-varus foot deformity (EVFD): Changes in dorsiflexion and space-time parameters during gait at 1 month after surgery

Effects of surgery and early rehabilitation treatment (ERT) on equino-varus foot deformity (EVFD): Changes in dorsiflexion and space-time parameters during gait at 1 month after surgery

Presence of accessory penis, colonic duplication and several other congenital anomalies in a child: a very rare association

An accessory penis is a very rare anomaly. Only five cases have been reported thus far to our knowledge. We present the case of a child aged 2 years and 10 months who had a penis-like structure (containing phallus and glans) attached to the right buttock. Associated anomalies were a non-communicating type of colonic duplication, a paramedian stenosed anal opening, a horse-shoe kidney, posterior urethral valves, scoliosis of the lumbo-sacral spine, polydactyly and equino-varus deformity of the right foot. As far as we can tell, this is the first report of an accessory penis associated with colonic duplication and other congenital anomalies.

Spinal dermoid presenting with equinovarus deformity of the foot: A Case Report

Spinal dermoid tumors are relatively rare tumors especially in the adult age group. These slow growing benign tumors may become symptomatic at a later age leading to pain and neurological deficits due to involvement of the nerve roots and the cauda equina. We present here a case of a 36-year-old woman who presented with gradually progressive equinovarus deformity of the foot and scoliosis. Magnetic resonance imaging (MRI) revealed a large spinal dermoid tumor at the thoracolumbar junction. CASE REPORT A-36-year-old woman presented for evaluation of gradually progressive equinovarus deformity of the left foot and scoliosis (Fig 1). Figure 1 Figure 1: Equinovarus deformity of the left foot. She first noticed that her left foot was turning inwards about a year ago but at that time did not seek medical attention. There was no history of trauma to the back and she denied any back or leg pain. Neurological examination revealed an equinovarus deformity of left foot and a slightly broad based gait (Video). MRI lumbosacral spine revealed a large dermoid tumor in the spinal canal situated at the thoracolumbar junction (Fig 2). Figure 2 Figure 2: T weighted MRI of the thoracolumbar spine showing a large spinal dermoid with fat content. X-ray of the lumbar spine revealed scoliosis (Fig 3). Surgical excision of the tumor was deferred taking into account the absence of pain or difficulty walking and the possibility of bladder incontinence post surgery. As of this writing she remains in close follow up. Spinal dermoid presenting with equinovarus deformity of the foot: A Case Report 2 of 3 Figure 3 Figure 3: X-ray lumbar spine showing scoliosis. Video: Patient video showing equinovarus deformity of foot while walking. DISCUSSION Dermoid tumors or cysts are not true neoplasms. They along with epidermoid tumors represent inclusion cysts consisting of ectodermal elements 1. They can either be congenital where in during third to fifth week of embryonic development the ectoderm might get entrapped in the neural tube giving rise to epidermoid and dermoid cysts. Trauma has been implicated in the generation of these benign tumors later in life. Rarely skin tissue may be forced into the vertebral canal during lumbar puncture or surgery giving rise to these cystic tumors. Spinal dermoid tumors are most commonly situated near the thoracolumbar junction and may be either intradural intramedullary or intradural extramedullary. Extradural location is the least common for these slow growing tumors. They may involve the conus medullaris and cauda equina leading to back and leg pain as well as weakness. Terai et al reported a case of adult onset tethered cord syndrome due to an intradural dermoid cyst 2. Due to the pain and sensory deficits their patient underwent laminectomy with decompression of the canal and excision of the intradural cyst. We decided to withhold any active neurosurgical intervention in our patient due to the absence of pain or difficulty walking and also taking into consideration the possibility of bladder incontinence post surgery. CORRESPONDENCE TO NK Sethi, MD Department of Neurology NYP-Weill Cornell Medical Center 525 East, 68 Street New York, NY 10021 Email: sethinitinmd@hotmail.com Tel: +646-515-5168

Poly-syndactyly of hands and feet with talipes equino-varus an unusual combination

A case of a fifteen year old male with unusual congenital anomalies of hands and feet (Poly-syndactyly) is presented. There was associated talipes equino-varus deformity of the left foot with bilateral duplication of great toes. Both hands appeared like a cup but the patient was able to carry out his routine activities. The purpose of this report is to document a unique ‘isolated’ congenital anomaly.

Poly-syndactyly of hands and feet with talipes equino-varus an unusual combination

A case of a fifteen year old male with unusual congenital anomalies of hands and feet (Poly-syndactyly) is presented. There was associated talipes equino-varus deformity of the left foot with bilateral duplication of great toes. Both hands appeared like a cup but the patient was able to carry out his routine activities. The purpose of this report is to document a unique 'isolated' congenital anomaly.