foot deformity in cp

[egy physio]

hi ,
i have patient for orthopaedic consultation , he is 5 y boy ,paraplegic ,Rt foot supination deformity.he walks with foot completely planterflexed sit W shaped ,no range of foot dorsiflexion........ how to accurately evalute & share in surgery decision ,thanks all

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[illuminatidinesh]

R u physio??????? Then all U can do is evaluate and prescribe for a good orthotics . Then only U can talk about the surgery. But then everything depends on the condition,and extent of deformity.

[egy physio]

of course iam physio , the surgeon of this case is asking for advise about it and any physio intervension can be done before and after surgery

[phunphysio]

Serial casting? If he is walking then serial casts into dorsiflexion with or without botox depending on strength may be appropriate. Orthotics will only help keep the foot in the corrected position once achieved, AFO or otherwise.

[estherderu]

dear egy physio,

First you will have to be sure that the foot does not have any structural bony deformaties. Is the tibia rotated?
Has a X-ray been taken to confirm this?
Is dorsiflexion possible with the knee bent? is the contracture caused by a single or a double joint problem?

How is his gait and do you have the possibilties to analyse this?

If you do not know much about gait, I suggest you try to get hold of Jim Gage Book on Gait in Cerebral palsy. Look for more information at Amazon.com: James R. Gage: Books

In the mean time you can learn a lot from the different gait websites such as:
Laboratory Methods
lots of specialist clinics around the world and some give workshops.. such as
Eventi Patrocinati dalla SIAMOC Società Italiana di Analisi del Movimento in Clinica in Italy
CMAS - what is movement analysis in the UK and Ierland

You can start using the FMS as classification tool
http://www.mcri.edu.au/Downloads/Gai...S_brochure.pdf

....and on this very website a Gait tool developed by a colleague.
http://www.physiobob.com/forum/paedi...gait-tool.html

The ideal situation is that the childs gait is analysed including his ROM and strength in hip,knee and ankle joints. The anti-gravity muscles need to be tested: the gluteus max, gluteus medius, vastus quadriceps,gastrocnemius and soleus.
Then, as a team, you have sufficient knowledge and should be able to decide what to do.
- If correction of the soft tissue is possible then serial casting is the best option.You can read more about it and if you are not familiar with this, try to find someone in your neighbourhood that is. It is not too difficult to learn and a very handy extra option for these children.
- it there is a bony lever arm problem, this has to be corrected first. This could be for example the internal rotation of the tibia or

Another treatment method is perhaps unknown.
Dynamic Movement Orthotics Limited

a paper on gait analysis. Free access journal
Journal of NeuroEngineering and Rehabilitation | Full text | Gait analysis methods in rehabilitation
there is enough knowledge out there, you have to know where to find it and then see what works for you.


good luck in your work,

Esther

[egy physio]

thanks alot everyone, i can get passive range of dorsiflexion with hip flexed and knee extended what do u think of passive stretching and using medical shoes (as he is ambulant )

[estherderu]

dear colleague,

The AACPDM have published a systematic review into the effects of casting.
This is the link to their page with more high level studies


American Academy for Cerebral Palsy and Developmental Medicine (AACPDM)

Casting has shown to be effective and stretching, only after obtaining a good mobility. Stretching has to be maintained for many hours to be effective and a night splint is the preferred treatment in many countries.

kind regards

Esther