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Freeman Miller - One of the best experts on this subject based on the ideXlab platform.
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crouch gait changes after planovalgus Foot Deformity correction in ambulatory children with cerebral palsy
Gait & Posture, 2014Co-Authors: Muayad Kadhim, Freeman MillerAbstract:Abstract Ambulatory children with cerebral palsy (CP) may present with several gait patterns due to muscular spasticity, commonly with crouch gait. Several factors may contribute to continuous knee flexion during gait, including hamstring and gastrocnemius contracture. In planovalgus Foot Deformity, the combination of heel equinus, talonavicular joint dislocation, midFoot break and external tibial torsion also contribute to crouch gait as part of lever arm dysfunction. In this retrospective cohort study, we assessed 21 children with CP (34 feet) who underwent planovalgus Foot correction as a single level surgery. Fifteen feet underwent subtalar fusion and 19 feet had lateral calcaneal lengthening. Patients who underwent knee, hip or pelvis surgeries were excluded from the study. The aim was to examine the changes in gait pattern and the correlation between the changes of knee flexion at stance phase with the other kinematic and kinetic parameters after Foot surgery. Post surgery change of Maximum knee extension at stance (MKE-dif) was the outcome of interest. The magnitude of change in MKE after surgery increased (less crouch after surgery) in patients who had milder preoperative planovalgus feet and higher preoperative ankle maximum dorsiflexion at stance and ankle power. The gain of knee extension after surgery correlated with correction of ankle hyperdorsiflexion and with increase of knee extension at initial contact and knee power. Patients with high preoperative ankle maximum dorsiflexion may benefit from surgical Foot Deformity correction to achieve decreased ankle dorsiflexion with no knee surgical intervention.
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correlation of radiographic and pedobarograph measurements in planovalgus Foot Deformity
Gait & Posture, 2012Co-Authors: Muayad Kadhim, Laurens Holmes, Freeman MillerAbstract:Abstract Planovalgus Foot Deformity is common in children with cerebral palsy. Several pathologies contribute to the Deformity. It begins with the lateral displacement of the navicular and the talar head becomes uncovered and prominent in the medial side of the midFoot. The purpose of this study was to assess the correlation between the radiographic and the pedobarographic measurements and the ability to predict Foot pressure components using radiographic measurement. The patient sample included 43 patients with cerebral palsy who were ambulatory and had planovalgus Foot Deformity (76 feet). Medial midFoot pressure showed correlation with talonavicular uncoverage index, talonavicular angle, medial arch angle, Meary angle, and lateral talocalcaneal angle. Heel impulse showed negative correlation with talonavicular uncoverage index and talonavicular angle. Simple linear regression was used to assess the relationship between radiographic and Foot pressure component measurements. For every unit change in talonavicular uncoverage index, the predicted value of medial midFoot pressure was [9.9 + 27 (talonavicular uncoverage index)]. This equation accounted for 17.9% of the changes in the medial midFoot pressure. Tibial Foot angle and maximum knee extension also contributed to the heel impulse. The radiographic indices of the planovalgus Foot can explain the changes in some Foot pressure components.
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recurrence after surgery for equinus Foot Deformity in children with cerebral palsy assessment of predisposing factors for recurrence in a long term follow up study
Journal of Children's Orthopaedics, 2011Co-Authors: Durga N Knowtharapu, Laurens Holmes, Kenneth J Rogers, Freeman MillerAbstract:Background Despite the large number of studies on the recurrence after surgery for equinus Foot Deformity in cerebral palsy (CP) patients, only a few investigations have reported long-term recurrence rates. Furthermore, little is known on the interval between the recurrent surgeries and the factors that lead to early recurrence. This study aimed to assess the overall recurrence after surgery for equinus Foot Deformity in patients with CP and to assess the factors associated with recurrence. We also aimed to determine the predisposing factors for early recurrence.
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long term follow up of surgery for equinovarus Foot Deformity in children with cerebral palsy
Journal of Pediatric Orthopaedics, 2002Co-Authors: Chia Hsieh Chang, Juan Pablo Albarracin, Glenn E Lipton, Freeman MillerAbstract:: The factors associated with failed operative intervention in the treatment of equinovarus Foot Deformity in children with cerebral palsy (CP) were evaluated after long-term follow-up. One hundred eight children with CP who had surgery on the posterior tibialis tendon (split tendon transfer, intramuscular lengthening, or Z-lengthening) on 140 feet were reviewed at a mean age of 16.8 years with 7.3 years of follow-up. The surgery was considered a failure when a 10 degrees or greater varus or valgus hindFoot Deformity was present or if an additional operative intervention was required or planned. Involvement of CP, age at operation, and preoperative status of ambulation were significant factors in the outcome of the surgery. Hemiplegic patients demonstrated the best results, regardless of age or surgical procedure. Seventy-five percent of diplegic and quadriplegic patients who were younger than 8 years or who were not capable of community ambulation failed operative intervention, and surgery on the posterior tibialis tendon is not recommended in this group of patients.
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lateral column lengthening as treatment for planovalgus Foot Deformity in ambulatory children with spastic cerebral palsy
Journal of Pediatric Orthopaedics, 2000Co-Authors: Antonio Andreacchio, Carlos A Orellana, Freeman Miller, Thomas R BowenAbstract:: The purpose of this study was to investigate the effectiveness of lateral column lengthening in the treatment of flexible, planovalgus Foot Deformity of ambulatory children with spastic cerebral palsy (CP). Fifteen ambulatory children (23 feet) with spastic CP and flexible planovalgus Foot deformities received lateral column lengthenings through the calcaneus or calcaneocuboid joint. At an average of 4.1 years of follow-up (minimum, 2.3 years), 17 (74%) feet had good, two (9%) had fair, and four (17%) had poor outcomes. Poor outcomes resulted from recurrence of Deformity. Improvements in preoperative, postoperative, and follow-up radiographic measurements were found. However, these improvements are not related to the clinical outcomes. Calcaneal lengthening is a successful treatment for flexible planovalgus Foot Deformity in ambulatory children with spastic CP. The high failure rate is a significant limitation to the procedure. Further investigation of the objective measurement of planovalgus Foot Deformity is needed.
Hae Ryong Song - One of the best experts on this subject based on the ideXlab platform.
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effect of Foot Deformity on conventional mechanical axis deviation and ground mechanical axis deviation during single leg stance and two leg stance in genu varum
Knee, 2007Co-Authors: Sameer Shrikrishna Desai, Gautam M Shetty, Hae Ryong SongAbstract:Abstract We assessed the effect of Foot Deformity on the loading axis of lower limbs in 33 patients with genu varum (25 bilateral and eigth unilateral) caused by varying etiologies including achondroplasia, cerebral palsy, prior trauma, rickets, metaphyseal chondrodysplasia and primary osteoarthritis using single leg stance and both leg stance radiographs. Deviation at the knee from the hip ankle line (conventional) and hip Foot line (centre of hip to centre of heel) was calculated. A comparison was made between single leg stance and two leg stance for tibiocalcaneal angle, mechanical axis angle, knee and ankle joint line convergence angle, conventional mechanical axis deviation (MADC) and ground mechanical axis deviation (MADG). In addition comparisons were also made among three groups formed depending on the tibiocalcaneal angle and MADC–MADG difference for all the above measurements. Mechanical axis deviation (calculated using the two methods) varied with the talocalcaneal angle and single leg stance. Patients with a fixed subtalar varus and with severe genu varum, where the normal compensatory subtalar eversion could not compensate showed that conventional mechanical axis deviation was significantly higher by 3.4 ± 2.4 mm and ground mechanical axis deviation degrees was significantly higher by 3.8 ± 3.2 mm in single leg stance when compared to two leg stance ( p Foot Deformity should be included during preoperative evaluation and planning for knee Deformity correction.
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tibial lengthening and concomitant Foot Deformity correction in 14 patients with permanent Deformity after poliomyelitis
Acta Orthopaedica, 2005Co-Authors: Hae Ryong Song, Valencia Myrboh, Chang Wug OhAbstract:Background In neuromuscular diseases, limb lengthening and Foot Deformity correction are associated with a high risk of complications associated with distraction callus and joint contracture. We have found no published articles of tibial lengthening and concomitant Foot Deformity correction using the Ilizarov method or traditional methods. To compare result of gradual distraction with triple arthrodesis for Foot Deformity combined with tibial lengthening, we investigated healing index and complications of two methods.Patients and methods We reviewed 14 patients with permanent Deformity after poliomyelitis who underwent tibial lengthening and concomitant Foot Deformity correction using the Ilizarov external fixator. Tibial lengthening over an intramedullary nail was performed in 3 patients and lengthening without a nail was performed in 11 patients.Results The mean external fixation time was 6 (3.6- 10) months without nail and 1.6 (1.5-1.7) months with nail, whereas the mean healing index was 1.8 (0.8-3.1)...
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tibial lengthening and concomitant Foot Deformity correction in 14 patients with permanent Deformity after poliomyelitis
Acta Orthopaedica Scandinavica, 2005Co-Authors: Hae Ryong Song, Valencia Myrboh, Chang Wug OhAbstract:Background In neuromuscular diseases, limb lengthening and Foot Deformity correction are associated with a high risk of complications associated with distraction callus and joint contracture. We have found no published articles of tibial lengthening and concomitant Foot Deformity correction using the Ilizarov method or traditional methods. To compare result of gradual distraction with triple arthrodesis for Foot Deformity combined with tibial lengthening, we investigated healing index and complications of two methods. Patients and methods We reviewed 14 patients with permanent Deformity after poliomyelitis who underwent tibial lengthening and concomitant Foot Deformity correction using the Ilizarov external fixator. Tibial lengthening over an intramedullary nail was performed in 3 patients and lengthening without a nail was performed in 11 patients. Results The mean external fixation time was 6 (3.6-10) months without nail and 1.6 (1.5-1.7) months with nail, whereas the mean healing index was 1.8 (0.8-3.1) months/cm without nail and 2 (1.8-2.3) months/cm with nail. Concomitant Foot treatments included triple arthrodesis in 7 patients, pantalar arthrodesis in 2 patients with flail ankle, and gradual Foot frame distraction without bony Foot procedures in 5 patients. Delayed consolidation and recurrent equinus contracture of the ankle requiring additional lengthening of the Achilles tendon were the most common bone and joint complications during tibial lengthening. Interpretation The gradual Foot frame distraction method was associated with major complications, such as recurrent Foot Deformity, joint luxation, and arthritis. We therefore recommend triple arthrodesis as a concomitant procedure during tibial lengthening.
Solange Perrin - One of the best experts on this subject based on the ideXlab platform.
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split anterior tibial tendon transfer for varus equinus spastic Foot Deformity initial clinical findings correlate with functional results a series of 132 operated feet
Foot and Ankle Surgery, 2011Co-Authors: Jean Claude Vogt, Gerard Bach, Bernard Cantini, Solange PerrinAbstract:Abstract Spastic equinovarus Foot Deformity commonly occurs after stroke or head trauma. Management by split anterior tibial tendon transfer to the lateral border of the Foot was chosen by the authors. The purpose of that work was to assess the reliability of this method to improve patient's functional autonomy and investigate the relationship between the initial clinical examination findings and the quality of the functional results. 84 feet, operated in 82 patients out of 130, of mean age 46 years, were reviewed at a mean follow-up of 65 months. Very few complications were observed. Toe deformities remain a commonly associated problem. 80 patients were able to walk bareFoot, 74 reported an increase in their walking distance, and 73 could regularly wear normal shoes. There is a strong relationship ( p
Jacques Battin - One of the best experts on this subject based on the ideXlab platform.
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split hand split Foot Deformity and ladd syndrome in a family overlap between the eec and ladd syndromes
Journal of Medical Genetics, 1993Co-Authors: D Lacombe, F Serville, D Marchand, Jacques BattinAbstract:A mother and daughter are reported with apparently dissimilar syndromes. The mother has a split hand/split Foot Deformity and the daughter a condition consistent with a diagnosis of LADD syndrome. Absence of clefting and deficient formation of saliva and tears are the main signs that differentiate the LADD from the EEC syndrome. However, no distinct feature is constant between these two autosomal dominant disorders that show great phenotypic variability. This report emphasises the overlap between the LADD and the EEC syndromes.
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Split hand/split Foot Deformity and LADD syndrome in a family: overlap between the EEC and LADD syndromes.
Journal of Medical Genetics, 1993Co-Authors: D Lacombe, F Serville, D Marchand, Jacques BattinAbstract:A mother and daughter are reported with apparently dissimilar syndromes. The mother has a split hand/split Foot Deformity and the daughter a condition consistent with a diagnosis of LADD syndrome. Absence of clefting and deficient formation of saliva and tears are the main signs that differentiate the LADD from the EEC syndrome. However, no distinct feature is constant between these two autosomal dominant disorders that show great phenotypic variability. This report emphasises the overlap between the LADD and the EEC syndromes.
D Mazzoli - One of the best experts on this subject based on the ideXlab platform.
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safety and long term effects on gait of hemiplegic patients in equinovarus Foot Deformity surgical correction followed by immediate rehabilitation a prospective observational study
European Journal of Physical and Rehabilitation Medicine, 2019Co-Authors: E Giannotti, A Merlo, P Zerbinati, P Prati, Stefano Masiero, D MazzoliAbstract:BACKGROUND: 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. AIM: To determine long-term safety and efficacy of functional surgery followed by early rehabilitation (FSER). DESIGN: A 12 months prospective observational study. SETTING: Outpatients clinic, Gait and Motion Laboratory, Sol et Salus Hospital, Rimini, Italy. POPULATION: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. CLINICAL REHABILITATION IMPACT: FSER can be considered an encouraging approach in the management of EVFD, with durable results.
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early rehabilitation treatment combined with equinovarus Foot Deformity surgical correction in stroke patients safety and changes in gait parameters
European Journal of Physical and Rehabilitation Medicine, 2016Co-Authors: E Giannotti, A Merlo, P Zerbinati, P Prati, Stefano Masiero, M Longhi, D MazzoliAbstract:BACKGROUND: Equinovarus Foot Deformity (EVFD) compromises several prerequisites of walking and increases the risk of falling. Guidelines on rehabilitation following EVFD surgery are missing in current literature. AIM: The aim of this study was to analyze safety and adherence to an early rehabilitation treatment characterized by immediate weight bearing with an ankle-Foot orthosis (AFO) in hemiplegic patients after EVFD surgery and to describe gait changes after EVFD surgical correction combined with early rehabilitation treatment. DESIGN: Retrospective observational cohort study. SETTING: Inpatient rehabilitation clinic. POPULATION: Forty-seven adult patients with hemiplegia consequent to ischemic or haemorrhagic stroke (L/R 20/27, age 56±15 years, time from lesion 6±5 years). METHODS: A specific rehabilitation protocol with a non-articulated AFO, used to allow for immediate gait training, started one day after EVFD surgery. Gait analysis (GA) data before and one month after surgery were analyzed. The presence of differences in GA space-time parameters, in ankle dorsiflexion (DF) values and peaks at initial contact (DF at IC), during stance (DF at St) and swing (DF at Sw) were assessed by the Wilcoxon Test while the presence of correlations between pre- and post-operative values by Spearman's correlation coefficient. RESULTS: All patients completed the rehabilitation protocol and no clinical complications occurred in the sample. Ankle DF increased one month after surgery at all investigated gait phases (Wilcoxon Test, P<0.0001), becoming neutral at IC. Significant (P<0.05) variations were found for stride length, stride width, anterior step length of the affected side and for the duration of the double support phase of the contralateral side. The postsurgery ankle DF at St was found to be correlated (R=0.81, P<0.0001) with its pre-surgery value, thus being predictable. Weaker significant correlations were found for DF at Sw and DF at IC, where contribution from the dorsiflexor muscles is required in addition to calf muscle passive lengthening. CONCLUSIONS: An orthosis-assisted immediate rehabilitation associated with surgical procedure is safe and may be suitable to correct EVFD by restoring both the neutral heel Foot-ground contact and the ankle DF peaks during stance and swing at one month from surgery. CLINICAL REHABILITATION IMPACT: The proposed protocol is a safe and potentially useful rehabilitative approach after EVFD surgical correction in stroke patients.