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ankle equinus

Jorik Nonnekes, Nathalie Benda, Hanneke van Duijnhoven, Frits Lem, Noël Keijsers, Jan Willem K Louwerens, Allan Pieterse, Bertjo Renzenbrink, Vivian Weerdesteyn, Jaap Buurke, Alexander C H Geurts
Importance: Gait impairments are common in patients with chronic supratentorial upper motor neuron lesions and are a source of disability. Clinical management aimed at improving the gait pattern in these patients is generally perceived as a challenging task because many possible abnormalities may interact. Moreover, a multitude of treatment options exist, ranging from assistive devices and muscle stretching to pharmacologic and surgical interventions, but evidence is inconclusive for most approaches and clear treatment guidelines are lacking...
February 26, 2018: JAMA Neurology
Maxime Delcour, Vicky S Massicotte, Michaël Russier, Hélène Bras, Julie Peyronnet, Marie-Hélène Canu, Florence Cayetanot, Mary F Barbe, Jacques-Olivier Coq
Motor control and body representation in the central nervous system (CNS) as well as musculoskeletal architecture and physiology are shaped during development by sensorimotor experience and feedback, but the emergence of locomotor disorders during maturation and their persistence over time remain a matter of debate in the absence of brain damage. By using transient immobilization of the hind limbs, we investigated the enduring impact of postnatal sensorimotor restriction (SMR) on gait and posture on treadmill, age-related changes in locomotion, musculoskeletal histopathology and Hoffmann reflex in adult rats without brain damage...
February 13, 2018: Brain Pathology
Zhengxun Li, Ning Zhang, Yang Wang, Songhua Cao, Zheng Huang, Yong Hu
BACKGROUND: Equinus of the ankle is a common deformity in spastic cerebral palsy. Achilles tendon lengthening is one of the effective options for the treatment of equinus deformity. METHODS: In the study, a new stair-shaped Achilles tendon lengthening (ATL) procedure that preserves of the tendon continuity was performed in 28 tendons with equinus deformity (20 patients, mean age=10.5±2.6 years). The results were compared with a group of patients treated with the Z-lengthening procedure...
October 27, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Anil Agarwal, Nargesh Agrawal, Sitanshu Barik, Neeraj Gupta
We evaluated the outcome of a new protocol of an extended Ponseti method in the management of idiopathic club foot with residual equinus following failed Achilles tenotomy. We also compared the failed with a successful tenotomy group to analyze the parameters for failure. The Ponseti technique-treated idiopathic club foot patients with failed percutaneous Achilles tenotomy (failure to achieve <15° dorsiflexion) were treated by continued stretching casts, with a weekly change for a further 3 weeks. Final dorsiflexion more than 15° if achieved with the above protocol was recorded as a success...
January 29, 2018: Journal of Pediatric Orthopedics. Part B
Rose E Cortina, Brandon L Morris, Bryan G Vopat
Metatarsalgia is a common cause of plantar forefoot pain. Causes of metatarsalgia include foot anatomy, gait mechanics, and foot and ankle deformity. One specific cause, mechanical metatarsalgia, occurs because of gastrocnemius muscle contracture, which overloads the forefoot. Muscular imbalance of the gastrocnemius complex alters gait mechanics, which increases recruitment of the toe extensor musculature, thereby altering forefoot pressure. Patients with concomitant metatarsalgia and gastrocnemius contracture demonstrate ankle equinus and a positive Silfverskiold test...
March 2018: Foot and Ankle Clinics
Teresa Martín Lorenzo, Eduardo Rocon, Ignacio Martínez Caballero, Ana Ramírez Barragán, Sergio Lerma Lara
Tissue related ankle hyper-resistance has been reported to contribute to equinus gait in children with spastic cerebral palsy. Hence, ankle plantarflexor stretching programs have been developed in order to restore passive ankle dorsiflexion. Despite high quality evidence on the limited effects of stretching on passive joint mobility, further muscle-tendon adaptations have been reported which may impact gait performance. As such, children with spastic cerebral palsy subject to long-term manual static stretching achieved dorsiflexion gains through the reduction of muscle and fascicle strain whilst preserving tendon strain, and prolonged use of ankle-foot orthoses achieved similar dorsiflexion gains through increased tendon strain whilst preserving muscle and fascicle strain...
November 2017: Medical Hypotheses
Yah-Ting Wu, Chih-Ning Chang, Yi-Min Chen, Gwo-Chi Hu
BACKGROUND: Recent studies have suggested that either focused or radial shock wave therapy is an effect method for the treatment of spasticity in patients with stroke. However, no previous study compared these two types of extracorporeal shock wave on spasticity in patients with stroke. This study aimed to compare the effect of focused and radial shock wave therapy for the treatment of spastic equinus in patients with stroke. DESIGN: Randomized control trial. SETTING: Outpatient rehabilitation center in a medical center...
October 25, 2017: European Journal of Physical and Rehabilitation Medicine
Jennifer L Mulhern, Nicole M Protzman, N Jake Summers, Stephen A Brigido
At present, there is a paucity of literature describing the clinical outcomes following a combined gastrocnemius recession and endoscopic plantar fasciotomy. The purpose of the present report is to describe our preliminary findings following a combined gastrocnemius recession and endoscopic plantar fasciotomy for the treatment of plantar fasciitis and gastrocnemius equinus recalcitrant to conservative therapy. Twenty-five consecutive ankles in 23 patients (age 51.2 ± 12.5 years, 4 men) met the inclusion and exclusion criteria...
October 1, 2017: Foot & Ankle Specialist
Wei Chen, Xiaoyu Liu, Fang Pu, Yang Yang, Lizhen Wang, Hong Liu, Yubo Fan
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)...
October 2017: Medicine (Baltimore)
Oussama Abousamra, Joshua Schwartz, Chris Church, Nancy Lennon, John Henley, Tim Niiler, Freeman Miller
This study aimed to assess the effects of plantar flexor lengthening (PFL) on dynamic foot pressures of children with cerebral palsy using pedobarographs. Of 97 enrolled, 13 children with 18 legs had PFL. Age at surgery was 4.7 (2.8-8.8) years. A significant increase in ankle dorsiflexion and heel impulse was achieved postoperatively and was maintained at 5 years. The coronal plane pressure index increased postoperatively, but reverted to preoperative levels at the 5-year follow-up. Children tend to have more valgus after PFL...
September 25, 2017: Journal of Pediatric Orthopedics. Part B
Yu-Bin Liu, Shu-Yun Jiang, Li Zhao, Yan Yu, Da-Hang Zhao
BACKGROUND: The prevention and treatment of relapsed clubfoot remained challenging tasks. There were controversies as to treatment options and management, such as complete subtalar release, application of an Ilizarov external frame, or repeated Ponseti method; and different options were available in different treatment centers. This study was designed to evaluate the clinical outcome of relapsed clubfeet treated by repeated Ponseti method in comparison with the cases without relapse in term of gait analysis and to clarify the clinical efficacy of repeated Ponseti method in treating the relapsed clubfeet...
September 22, 2017: Journal of Pediatric Orthopedics
Michèle Kläusler, Bernhard Maria Speth, Reinald Brunner, Oren Tirosh, Carlo Camathias, Erich Rutz
Using Tibialis Anterior Shortening (TATS) in combination with Achilles Tendon Lengthening (TAL) to treat spastic equinus in children with cerebral palsy (CP) was described in 2011. Short-term results have indicated a good outcome, especially an improvement of the drop foot in swing phase and the correction of equinus in stance phase. The aim of this study was to analyse the results of the long-term follow-up and to determine the relapse rate of TATS and TAL. The kinematics of the sagittal, frontal and transversal planes were measured by using instrumented 3D gait analysis at three defined time points and then described using the Gait Profile Score (GPS) and Movement Analysis Profile (MAP)...
October 2017: Gait & Posture
Alessandro Picelli, Gabriella Vallies, Elena Chemello, Paola Castellazzi, Annalisa Brugnera, Marialuisa Gandolfi, Alessio Baricich, Carlo Cisari, Andrea Santamato, Leopold Saltuari, Andreas Waldner, Nicola Smania
Spasticity is common in stroke and multiple sclerosis. To treat spasticity we have a wide range of interventions, whose application may depend not only on the severity of spasticity but also on its etiology. Consequently, a better understanding of muscle spasticity in different neurological diseases may inform clinicians as to the more appropriate therapeutic approach. Our aim was to compare the clinical and ultrasonographic features of spastic equinus in patients with chronic stroke and multiple sclerosis...
September 15, 2017: Journal of the Neurological Sciences
Gustavo Vinagre, Matías Alfonso, Sebastián Cruz-Morande, Miguel Hernández, Carlos Villas
PURPOSE: Proximal medial gastrocnemius recession (PMGR) is a surgical procedure performed in patients with gastrocnemius tightness (GT). The purpose of this study is to evaluate the efficacy of pedobarographic analysis on PMGR in patients with GT and metatarsalgia. METHODS: This prospective study included 52 patients diagnosed with GT treated surgically with PMGR and 49 non-operated upon patients (control group). A total of 55 PMGRs (three bilateral) were performed as an isolated or combined procedure in the treatment group...
November 2017: International Orthopaedics
Philip Ellison, Andrew Molloy, Lyndon William Mason
Conservative "functional" management of acute Achilles tendon ruptures has become increasingly popular. Critical to this is the use of the walking orthosis, which positions the ankle in equinus to allow for early weightbearing. Our aim was to test whether 2 common orthoses achieved a satisfactory equinus position. A total of 11 sequentially treated Achilles tendon ruptures were assigned to either a fixed angle walking boot with wedges (FAWW) or an adjustable external equinus-corrected brace (EEB). The lateral radiographs of the cast immobilized tendons showed a mean tibiotalar angle (TTA) of 56° (range 54° to 57°) and a mean tibio-first metatarsal angle (1MTA) of 74° (range 62° to 85°)...
September 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Hyun Jung Chang, Bo Young Hong, Sang-Jee Lee, Soyoung Lee, Joo Hyun Park, Jeong-Yi Kwon
The objective of this clinical trial was to compare the efficacy and safety of letibotulinum toxin A and onabotulinum toxin A for improving dynamic equinus foot deformity in children with cerebral palsy (CP). In total, 144 children with spastic CP who had dynamic equinus foot deformity were assigned randomly to the Botulax group (injection of letibotulinum toxin A) or the Botox group (injection of onabotulinum toxin A). The Physician's Rating Scale (PRS), ankle plantar flexor spasticity using the Modified Tardieu Scale, the Gross Motor Function Measure (GMFM)-88, and the GMFM-66 were completed before injection and at 6, 12, and 24 weeks after injection...
August 18, 2017: Toxins
F E Navarrete, J Gómez-Alessandri, M Tintó, M Sánchez-González, V Vicent
Articular tuberculosis of the ankle joint is a rare presentation of skeletal tuberculosis (10% of cases). This unusual location and the low index of clinical suspicion leads to delays in diagnosis and treatment. Radiographic and analytic studies are unspecific in the first stage. CAT and MRI are useful in diagnosis. Chemotherapy is the mainstay of treatment and surgery is often required to establish the diagnosis and in the treatment. We report a case of ankle tuberculosis in a 22 month-old child. The diagnosis was confirmed by synovial biopsy...
July 26, 2017: Revista Española de Cirugía Ortopédica y Traumatología
Hany Hefny, ElHussein M Elmoatasem, Mahmoud Mahran, Tamer Fayyad, Mohamed A Elgebeily, Ahmed Mansour, Mamdouh Hefny
BACKGROUND: Fibular hemimelia is a congenital disorder that is characterized by the absence of the fibula that could be either partial or complete. Successful management aims to restore normal weight bearing and normal limb length. The introduction of the Ilizarov method of limb lengthening has provided an attractive alternative to amputation. During lengthening, the tight posterolateral soft-tissue structures, the thick fibrous fibular band, and the shortened Achilles tendon become tighter and transfer a valgus force to the talus and calcaneus, further aggravating the deformity...
July 2017: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
Marybeth Barkocy, James Dexter, Colleen Petranovich
PURPOSE: To evaluate the effectiveness of serial casting in a child with autism spectrum disorder (ASD) exhibiting a toe-walking gait pattern with equinus contractures. SUMMARY OF KEY POINTS: Although many children with ASD toe walk, little research on physical therapy interventions exists for this population. Serial casting has been validated for use in idiopathic toe walking to increase passive dorsiflexion and improve gait, but not for toe walking in children with ASD...
July 2017: Pediatric Physical Therapy
David Rodríguez-Sanz, Marta Elena Losa-Iglesias, Daniel López-López, César Calvo-Lobo, Patricia Palomo-López, Ricardo Becerro-de-Bengoa-Vallejo
Gastrocnemius-soleus equinus (GSE) is a foot-ankle complaint in which the extensibility of the gastrocnemius (G) and soleus muscles (triceps surae) and ankle are limited to a dorsiflexion beyond a neutral ankle position. The asymmetric forces of leg muscles and the associated asymmetric loading forces might promote major activation of the triceps surae, tibialis anterior, transverses abdominal and multifidus muscles. Here, we made infrared recordings of 21 sportsmen (elite professional soccer players) before activity and after 30 min of running...
2017: PeerJ
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