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Schröder JH, Barandun GA, Leimer P, Morand R, Göpfert B, Rutz E. Novel Modular Walking Orthosis (MOWA) for Powerful Correction of Gait Deviations in Subjects with a Neurological Disease. Children (Basel) 2023; 11:30. [PMID: 38255343 PMCID: PMC10813927 DOI: 10.3390/children11010030] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
This article introduces a novel concept where advanced technologies have been leveraged to produce a modular walking orthosis (MOWA) within a completely digital process chain. All processes of this new supply chain are described step-by-step. The prescription and treatment of lower leg orthoses for individuals with paralysis or muscle weakness, particularly cerebral palsy (CP), are complex. A single case study indicates successful treatment with this new orthosis (MOWA). From the authors' perspective, this innovative fitting concept is promising and will contribute to creating more efficient care within a multidisciplinary team.
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Affiliation(s)
| | - Gion A. Barandun
- IWK Institute for Materials Technology and Plastics Processing, Eastern Switzerland University of Applied Sciences, 8640 Rapperswil, Switzerland;
| | - Pascal Leimer
- Switzerland Innovation Park Biel/Bienne, 2503 Biel, Switzerland;
| | - Rafael Morand
- Biomedical Engineering Lab, Institute for Human Centered Engineering, Bern University of Applied Sciences, 3008 Bern, Switzerland;
| | - Beat Göpfert
- Department Biomedical Engineering (DBE), University of Basel, 4123 Allschwil, Switzerland;
- Laboratory for Movement Analysis, University of Basel Children’s Hospital (UKBB), 4056 Basel, Switzerland
| | - Erich Rutz
- The Royal Children’s Hospital, Melbourne, VIC 3052, Australia
- Bob Dickens Chair Paediatric Orthopaedic Surgery, The University of Melbourne, Melbourne, VIC 3010, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
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Nada DW, El Sharkawy AM, Elbarky EM, Rageh ESM, Allam AES. Radial extracorporeal shock wave therapy as an additional treatment modality for spastic equinus deformity in chronic hemiplegic patients. A randomized controlled study. Disabil Rehabil 2023:1-9. [PMID: 37926696 DOI: 10.1080/09638288.2023.2278185] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE To evaluate the effectiveness of radial extracorporeal shock wave therapy (r ESWT) as an additional treatment modality for spastic equinus deformity in chronic hemiplegic patients. METHODS 100 eligible stroke patients with calf muscles spasticity were randomized into 2 groups. Group I: 50 patients exposed to rESWT 1.500 pulses, 0.10 mJ to 0.3mJ/mm2, with a frequency 4 Hz once weekly for one month. Group II: 50 patients exposed to Sham rESWT once weekly for one month. Clinical, electrophysiological & musculoskeletal ultrasound assessments were done for all patients. RESULTS After controlling baseline as covariate, the trend for modified Ashworth scale (MAS), Passive ankle dorsiflexion motion (PADFM), 10 meters walk test (10-MWT), and Ratio of maximum H reflex to maximum M response (H/M ratio) after one & two months was significantly different between the two groups, with improvement of all clinical and electrophysiological parameters in group I. CONCLUSION ESWT represents a useful non-invasive, additional modality for the reduction of foot spasticity and equinus deformity in stroke patients.
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Affiliation(s)
- Doaa Waseem Nada
- Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amira Mohamed El Sharkawy
- Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Elham Mahmoud Elbarky
- Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - El Sayed Mohamed Rageh
- Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Abdallah El Sayed Allam
- Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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PICELLI A, CENSO RD, ZADRA A, FACCIOLI S, SMANIA N, FILIPPETTI M. Management Of Spastic Equinovarus Foot in Children with Cerebral Palsy: An Evaluation of Anatomical Landmarks for Selective Nerve Blocks of the Tibial Nerve Motor Branches. J Rehabil Med 2023; 55:jrm00370. [PMID: 36807992 PMCID: PMC9972165 DOI: 10.2340/jrm.v55.4538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/13/2022] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE To define the anatomical landmarks of tibial motor nerve branches for selective motor nerve blocks of the gastrocnemii, soleus and tibialis posterior muscles in the management of spastic equinovarus foot. DESIGN Observational study. PATIENTS Twenty-four children with cerebral palsy with spastic equinovarus foot. METHODS Considering the affected leg length, motor nerve branches to the gastrocnemii, soleus and tibialis posterior muscles were tracked using ultrasonography, and located in the space (vertical, horizontal, deep) according to the position of fibular head (proximal/distal) and a virtual line from the middle of popliteal fossa to the Achilles tendon insertion (medial/lateral). RESULTS Location of motor branches was defined as percentage of the affected leg length. Mean coordinates were: for the gastrocnemius medialis 2.5 ± 1.2% vertical (proximal), 1.0 ± 0.7% horizontal (medial), 1.5 ± 0.4% deep; for the gastrocnemius lateralis 2.3 ± 1.4% vertical (proximal), 1.1 ± 0.9% horizontal (lateral), 1.6 ± 0.4% deep; for the soleus 2.1 ± 0.9% vertical (distal), 0.9 ± 0.7% horizontal (lateral), 2.2 ± 0.6% deep; for the tibialis posterior 2.6 ± 1.2% vertical (distal), 1.3 ± 1.1% horizontal (lateral), 3.0 ± 0.7% deep. CONCLUSION These findings may help the identification of tibial motor nerve branches to perform selective nerve blocks in patients with cerebral palsy with spastic equinovarus foot.
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Affiliation(s)
- Alessandro PICELLI
- Neuromotor and Cognitive Rehabilitation Research Centre, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy,Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy,Canadian Advances in Neuro-Orthopaedics for Spasticity Congress (CANOSC), Kingston, ON, Canada
| | - Rita Di CENSO
- Neuromotor and Cognitive Rehabilitation Research Centre, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro ZADRA
- Neuromotor and Cognitive Rehabilitation Research Centre, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Silvia FACCIOLI
- AUSL IRCCS di Reggio Emilia, Reggio Emilia, Italy,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola SMANIA
- Neuromotor and Cognitive Rehabilitation Research Centre, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy,Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| | - Mirko FILIPPETTI
- Neuromotor and Cognitive Rehabilitation Research Centre, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy,Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
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Fuentes P, Cuchacovich N, Gutierrez P, Hube M, Bastías GF. Treatment of Severe Rigid Posttraumatic Equinus Deformity With Gradual Deformity Correction and Arthroscopic Ankle Arthrodesis. Foot Ankle Int 2021; 42:1525-1535. [PMID: 34142580 DOI: 10.1177/10711007211018201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Posttraumatic ankle equinus is associated with rigid deformity, poor skin condition, and multiple prior surgeries. Open acute correction has been described using osteotomies, talectomy, and arthrodesis, but concerns exist about skin complications, neurologic alterations, secondary limb discrepancy, and bone loss. Gradual correction using a multiplanar ring fixator and arthroscopic ankle arthrodesis (AAA) may decrease these complications. METHODS We retrospectively reviewed patients undergoing correction of posttraumatic rigid equinus with at least 1 year of follow-up after frame removal. The procedure consisted of percutaneous Achilles lengthening, gradual equinus correction using a multiplanar ring fixator, and AAA retaining the fixator in compression with screw augmentation. Frame removal depended on signs of union on the computed tomography scan. Visual analog scale (VAS) and Foot Function Index (FFI) scores were assessed as well as preoperative and postoperative x-rays. Complications were noted throughout the follow-up period. RESULTS Five patients were treated with a mean age of 35 years and mean follow-up of 31 months. Deformities were gradually corrected into a plantigrade foot over an average duration of 6 weeks. Union was achieved in all patients with a mean time of an additional 25 weeks, for a mean total frame time of 31 weeks. The mean preoperative tibiotalar angle was 151 degrees and was corrected to 115 degrees. FFI score improved from a mean of 87 to 24 and VAS from 8 to 2. CONCLUSION Posttraumatic rigid equinus can be treated effectively using gradual correction followed by integrated AAA in a safe and reproducible manner. Patients in this series had excellent functional, radiological, and satisfaction results. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Patricio Fuentes
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital del Trabajador, Santiago, Chile
| | - Natalio Cuchacovich
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital del Trabajador-Clinica Las Condes, Santiago, Chile
| | - Paulina Gutierrez
- Department of Emergency Medicine, Clinica Las Condes, Santiago, Chile
| | - Maximiliano Hube
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital del Trabajador-Clinica Indisa, Santiago, Chile
| | - Gonzalo F Bastías
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital del Trabajador-Clinica Las Condes, Hospital San Jose-Universidad de Chile, Santiago, Chile
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Lee W, Yoo B, Park D, Hong J, Shim D, Choi J, Rha DW. Analysis of foot kinematics during toe walking in able-bodied individuals using the Oxford Foot Model. Comput Methods Biomech Biomed Engin 2021; 25:833-839. [PMID: 34806516 DOI: 10.1080/10255842.2021.1982913] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Various neurological and musculoskeletal disorders can induce pathologic toe walking and lead to changes in foot kinematics. In this study, we analyzed the differences in foot kinematics between toe walking and heel-toe walking (HW) in able-bodied individuals. Twenty young healthy adults performed three gaits: HW, comfortable-height toe walking (CTW), and maximum-height toe walking (MTW). Oxford Foot Model was used for gait analysis. Toe walking showed increase of forefoot plantarflexion and hindfoot internal rotation compared to HW. Thus, our results may help distinguish the pathologic mechanism of the equinus gait in various disorders from the kinematic change of toe walking itself.
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Affiliation(s)
- Wonhee Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Beomki Yoo
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dongho Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Juntaek Hong
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dain Shim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joongon Choi
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Wook Rha
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
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Zargarbashi R, Abdi R, Bozorgmanesh M, Panjavi B. Anterior Distal Hemiepiphysiodesis of Tibia for Treatment of Recurrent Equinus Deformity Due to Flat-Top Talus in Surgically Treated Clubfoot. J Foot Ankle Surg 2021; 59:418-422. [PMID: 32131014 DOI: 10.1053/j.jfas.2019.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/25/2019] [Accepted: 08/18/2019] [Indexed: 02/03/2023]
Abstract
Treatment of persistent or recurrent equinus after repeated surgical releases can be challenging in patients with clubfoot. Anterior distal tibial epiphysiodesis has recently been used in patients with recurrent progressive equinus deformity, with inconsistent outcomes. Herein, we used this technique in a carefully selected subgroup (8 children, 9 feet) of patients with a severe equinus deformity and a flat-top talus. The patients were followed up with radiological and clinical measures for 12 to 18 months. The mean angle of the ankle improved significantly (25.5°, p < .0001). The mean anterior distal tibial angle decreased from 86.3° to 69° (p < .0001). Plantigrade foot was obtained in all patients, except 1 with arthrogryposis. When applied to carefully selected patients, anterior distal hemiepiphysiodesis of the tibia is an effective method for management of recurrent equinus deformity.
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Affiliation(s)
- Ramin Zargarbashi
- Associate Professor, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Abdi
- Assistant Professor, Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Bozorgmanesh
- Surgeon, Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Behnam Panjavi
- Associate Professor, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Associate Professor, Imam Reza Hospital, Birjand University of Medical Sciences, Birjand, Iran
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Campanini I, Cosma M, Manca M, Merlo A. Added Value of Dynamic EMG in the Assessment of the Equinus and the Equinovarus Foot Deviation in Stroke Patients and Barriers Limiting Its Usage. Front Neurol 2020; 11:583399. [PMID: 33329327 PMCID: PMC7717981 DOI: 10.3389/fneur.2020.583399] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022] Open
Abstract
Equinus (EFD) and equinovarus foot deviation (EVFD) are the most frequent lower limb deformities in stroke survivors. The equinus component can be triggered by a combination of dorsiflexor deficits, plantar flexor overactivity, muscle stiffness, and contractures. The varus component is typically due to an imbalance between invertor and evertor muscle actions. An improvement in identifying its causes leads to a more targeted treatment. These deformities are typically assessed via a thorough clinical evaluation including the assessment of range of motions, force, spasticity, pain, and observational gait analysis. Diagnostic nerve blocks are also being increasingly used. An advantage of dynamic electromyography (dEMG) is the possibility of measuring muscle activity, overactivity or lack thereof, during specific movements, e.g., activity of both ankle plantar flexors and dorsiflexors during the swing phase of gait. Moreover, fine-wire electrodes can be used to measure the activity of deep muscles, e.g., the tibialis posterior. An impediment to systematic use of dEMG in the assessment of EFD and EVFD, as a complimentary tool to the clinical evaluation, is a lack of evidence of its usefulness. Unfortunately, there are few studies found in literature. In order to fill this void, we studied three pairs of patients suffering from chronic hemiparesis consequent to a stroke, with EFD or EVFD. At the initial evaluation they all displayed the same clinical traits, very similar walking patterns, and an overlapping gait kinematics. However, the patterns of muscle activity differed considerably. dEMG data acquired during walking provided information that was not available from the sole clinical assessment. The contribution of this information to the subsequent clinical and rehabilitation process was discusses along with the barriers that limit the use of dEMG as a routine tool in neurorehabilitation.
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Affiliation(s)
- Isabella Campanini
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, S. Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michela Cosma
- Motion Analysis Laboratory, Department of Neuroscience and Rehabilitation, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Mario Manca
- Rehabilitation Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Andrea Merlo
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, S. Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Merlo Bioengineering, Parma, Italy
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Picelli A, Battistuzzi E, Filippetti M, Modenese A, Gandolfi M, Munari D, Smania N. Diagnostic nerve block in prediction of outcome of botulinum toxin treatment for spastic equinovarus foot after stroke: A retrospective observational study. J Rehabil Med 2020; 52:jrm00069. [PMID: 32432331 DOI: 10.2340/16501977-2693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the role of diagnostic nerve block in predicting the outcome of subsequent botulinum toxin type A treatment for spastic equinovarus foot due to chronic stroke. DESIGN Retrospective observational study. PATIENTS Fifty chronic stroke patients with spastic equinovarus foot. METHODS Each patient was given diagnostic tibial nerve block (lidocaine 2% perineural injection) assessment followed by botulinum toxin type A inoculation into the same muscles as had been targeted by the nerve block. All patients were evaluated before diagnostic nerve block, after the nerve block, and 4 weeks after botulinum toxin injection. Outcomes were ankle dorsiflexion passive range of motion of the affected side, and calf muscle spasticity, measured with the modified Ashworth scale and the Tardieu Scale. RESULTS Significant improvements were measured after diagnostic nerve block and botulinum toxin injection compared with the baseline condition. Diagnostic nerve block led to significantly greater improvements in all outcomes than botulinum toxin injection. CONCLUSION This study confirmed diagnostic nerve block as a valuable screening tool in deciding whether to treat spastic equinovarus with botulinum toxin. However, the results support the evidence that diagnostic nerve block results in a greater reduction in muscle overactivity than does botulinum toxin type A in patients with spastic equinovarus due to stroke.
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Affiliation(s)
- Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences,, University of Verona, IT-37134 Verona, Italy. E-mail:
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Fathi M, Hussein AS, M Elghazaly S, Al-Kinawy AM, Abdeltawab AK, Mansour YM, Elbehbeh NA, Sherif A, Afifi AM. Effect of Botulinum Toxin on Equinus Foot Deformity in Cerebral Palsy Patients: A Systematic Review and Network Meta-analysis. Curr Pharm Des 2020; 26:4796-4807. [PMID: 32418518 DOI: 10.2174/1381612826666200518105633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/15/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is a brain disorder that affects the development, movement and posture leading to limitation of Range of Movement (ROM) in the growing children. CP leads to deformities such as equinus foot deformity. We aim to investigate the efficacy of different botulinum toxin (BTX) products with or without serial casting in reducing the muscle spasticity in equinus foot deformity in patients with CP. METHODS A systematic review of the literature was performed by searching different electronic databases. Pub- Med, Scopus, Web of Science (WOS), and GHL databases were used. We analyzed the extracted data by network meta-analysis method using the R software package (version 3.5.0). RESULTS Regarding Modified Ashworth score (MAS), BTX-A was superior compared to placebo and BTX-A plus immediate casting (MD = -0.39, 95% CI [-0.60; -0.18]) and (MD = -0.50, 95% CI [-0.98; -0.02]), respectively. Concerning growth motor function movement Classification System (GMFM), Neuronox ranked above at 3 months (MD = -1.60, 95% CI [-2.87; -0.33]) and at six months (MD = -1.90, 95% CI [-3.48; -0.32]) compared to BTX-A. Regarding the Modified Tardieu scale (MTS) with knee flexion, BTX-A was superior to BTX-A plus immediate casting (MD = 8.60, 95% CI [1.76; 15.44]). Concerning passive range of movement (PROM) with Knee flexion or extension at 3 months, BTX-A showed a significant improvement compared to BTX-A plus immediate casting. CONCLUSION BTX-A ranked best on a physician rating scale (PRS), MAS, MTS with knee flexion and PROM (Knee flexion and extension) compared to Neuronox and Botulax. BTX-A alone was also better than BTX-A plus immediate casting.
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Affiliation(s)
| | | | | | | | | | | | | | - Ahmed Sherif
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed M Afifi
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Picelli A, Chemello E, Verzini E, Ferrari F, Brugnera A, Gandolfi M, Saltuari L, Modenese A, Smania N. Anatomical landmarks for tibial nerve motor branches in the management of spastic equinovarus foot after stroke: An ultrasonographic study. J Rehabil Med 2019; 51:380-384. [PMID: 30843081 DOI: 10.2340/16501977-2543] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To identify the anatomical landmarks of tibial motor nerve branches to the gastrocnemii, soleus and tibialis posterior muscles for selective motor nerve blocks in the management of spastic equinovarus foot. DESIGN Observational study. PATIENTS Twenty-five chronic stroke patients with spastic equinovarus foot. METHODS Motor nerve branches to the gastrocnemii, soleus and tibialis posterior muscles were tracked in the affected leg, using ultrasonography, and located in the space (vertical, horizontal and deep) according to the position of the fibular head (proximal/distal) and a virtual line from the middle of the popliteal fossa to the Achilles tendon insertion (medial/lateral). RESULTS Mean coordinates for the gastrocnemius medialis motor branch were: 1.5 cm (standard deviation (SD) 2.7) vertical (proximal), 1.7 cm (SD 1.3) horizontal (medial), 1.1 cm (SD 0.4) deep; for the gastrocnemius lateralis motor branch: 0.9 cm (SD 2.2) vertical (proximal), 1.8 cm (SD 1.7) horizontal (lateral), 1.0 cm (SD 0.3) deep; for the soleus motor branch: 1.4 cm (SD 1.1) vertical (distal), 1.6 cm (SD 0.7) horizontal (lateral), 2.8 cm (SD 0.7) deep; and for the tibialis posterior motor branch: 4.3 cm (SD 1.5) vertical (distal), 1.9 cm (SD 0.9) horizontal (lateral), 4.2 cm (SD 0.8) deep. CONCLUSION These findings may help in the identification of tibial motor nerve branches to the gastrocnemii, soleus and tibialis posterior muscles for selective motor nerve blocks in the management of spastic equinovarus foot.
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Affiliation(s)
- Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, IT-37134 Verona, Italy.
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Mulhern JL, Protzman NM, Summers NJ, Brigido SA. Clinical Outcomes Following an Open Gastrocnemius Recession Combined With an Endoscopic Plantar Fasciotomy. Foot Ankle Spec 2018; 11:330-334. [PMID: 29025282 DOI: 10.1177/1938640017733097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED 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. The average follow-up was 3.7 months. Compared across time, there were statistically significant improvements in pain, t(24) = 7.878, P < .001; dorsiflexion, t(24) = -6.125, P < .001; and eversion, t(23) = -3.610, P = .001. Plantar flexion and inversion remained similar across time ( P = .722 and P = .268, respectively). No statistically significant correlations were found between age and any of the postoperative outcome variables ( P ≥ .056) or body mass index and any of the postoperative outcome variables ( P ≥ .140). The authors believe that an isolated plantar fasciotomy alleviates symptoms in the majority of patients. When gastrocnemius equinus is also present, however, the authors advocate performing an open gastrocnemius recession as well. If the gastrocnemius pathology is not addressed, symptoms are likely to persist. The findings of the present report confirm the effectiveness of a combined gastrocnemius recession and endoscopic plantar fasciotomy to improve pain and range of motion. LEVELS OF EVIDENCE Case series, Level IV: Retrospective.
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Affiliation(s)
- Jennifer L Mulhern
- Coordinated Health, Bethlehem, Pennsylvania (JLM, NMP, NJS, SAB).,Martin Foot and Ankle, Lancaster, Pennsylvania (JLM).,Coordinated Health, Allentown, Pennsylvania (NMP).,Dartmouth-Hitchcock, Bedford, New Hampshire (NJS).,Clinical Sciences Department, The Commonwealth Medical College, Scranton, Pennsylvania (SAB)
| | - Nicole M Protzman
- Coordinated Health, Bethlehem, Pennsylvania (JLM, NMP, NJS, SAB).,Martin Foot and Ankle, Lancaster, Pennsylvania (JLM).,Coordinated Health, Allentown, Pennsylvania (NMP).,Dartmouth-Hitchcock, Bedford, New Hampshire (NJS).,Clinical Sciences Department, The Commonwealth Medical College, Scranton, Pennsylvania (SAB)
| | - N Jake Summers
- Coordinated Health, Bethlehem, Pennsylvania (JLM, NMP, NJS, SAB).,Martin Foot and Ankle, Lancaster, Pennsylvania (JLM).,Coordinated Health, Allentown, Pennsylvania (NMP).,Dartmouth-Hitchcock, Bedford, New Hampshire (NJS).,Clinical Sciences Department, The Commonwealth Medical College, Scranton, Pennsylvania (SAB)
| | - Stephen A Brigido
- Coordinated Health, Bethlehem, Pennsylvania (JLM, NMP, NJS, SAB).,Martin Foot and Ankle, Lancaster, Pennsylvania (JLM).,Coordinated Health, Allentown, Pennsylvania (NMP).,Dartmouth-Hitchcock, Bedford, New Hampshire (NJS).,Clinical Sciences Department, The Commonwealth Medical College, Scranton, Pennsylvania (SAB)
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Abstract
BACKGROUND The objective of the study was to evaluate the accuracy of percutaneous Achilles tendon lengthening (TAL) using a triple hemisection technique and the improvement in ankle dorsiflexion. METHODS Ten fresh-frozen above-knee cadaveric specimens were used. A percutaneous triple hemisection of the Achilles tendon (proximal, intermediate, and distal) was performed. Maximum ankle dorsiflexion was evaluated pre- and postprocedure with a digital goniometer. After proper dissection, the relative width of the cuts was noted. Following forced ankle dorsiflexion, displacement in the tensile gaps was measured in all 3 cuts with a precision digital caliper. RESULTS The overall relative width of the percutaneous cut was 51.3% ± 16.3% of the Achilles tendon diameter, 44.3% ± 13.6% for the proximal cut, 50.3% ± 15.6% for the intermediate cut, and 59.3% ± 18.4% for the distal cut. Tendon excursion averaged 13.0 ± 3.8 mm for the proximal cuts, 12.5 ± 4.7 mm for the intermediate cuts, and 8.2 ± 3.7 mm for the distal cuts. One cadaver had a complete rupture of the Achilles tendon and was excluded from the excursion data analysis. The mean range of motion for ankle dorsiflexion was 8.1 ± 3.9 degrees preprocedure and 27.6 ± 5.3 degrees postprocedure. The dorsiflexion angle significantly increased ( P < .0001) at an average of 19.5 ± 5.0 degrees following TAL. CONCLUSION Our cadaveric study demonstrated that the percutaneous triple hemisection of the Achilles was an accurate technique that provided successful lengthening of the tendon and increased ankle dorsiflexion. Complete ruptures are possible complications. CLINICAL RELEVANCE Our cadaveric study showed that in a clinical situation, triple hemisections of the Achilles tendon can be performed reliably, with significant improvement of the ankle dorsiflexion, mainly through increased tendon excursion at the proximal and intermediate cuts, and with low risk of complete ruptures.
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Affiliation(s)
- Sierra Phillips
- 1 Department of Orthopaedic Surgery, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Ashish Shah
- 1 Department of Orthopaedic Surgery, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Jackson Rucker Staggers
- 1 Department of Orthopaedic Surgery, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Martim Pinto
- 1 Department of Orthopaedic Surgery, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | | | - Sameer Naranje
- 1 Department of Orthopaedic Surgery, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Cesar de Cesar Netto
- 1 Department of Orthopaedic Surgery, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
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