Cases reported "Equinus Deformity"

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1/22. Fibular nonunion and equinovarus deformity secondary to posterior tibial tendon incarceration in the syndesmosis: a case report after a bimalleolar fracture-dislocation.

    A 39-year-old woman sustained a grade II open bimalleolar fracture-dislocation of the left ankle. Six months after an ORIF of these fractures was performed, she presented with a nonunion of the distal fibula fracture and with a fixed hindfoot equinovarus and forefoot adduction deformity. At surgery for repair of the fibular nonunion, the posterior tibial tendon (PTT) was found to be entrapped in the posterior tibiotalar joint, with a portion of the tendon interposed between the tibia and the fibula in the area of the posterior syndesmosis. After extrication of the PTT, the hindfoot varus and forefoot adduction deformity were corrected. To our knowledge, this is the first case report in the English literature of a missed PTT syndesmotic entrapment that resulted in a fibular nonunion and in a fixed foot deformity after an open bimalleolar ankle fracture dislocation. ( info)

2/22. Foot deformity in frontometaphyseal dysplasia (Gorlin-Cohen syndrome): a case report.

    A case of frontometaphyseal dysplasia (Gorlin-Cohen syndrome) in a child is described. The boy showed characteristic musculoskeletal changes, and had bilateral symptomatic cavovarus deformities of the feet. Surgical management of the foot deformities and the outcome are discussed. ( info)

3/22. Treatment of severe equinus deformity associated with extensive scarring of the leg.

    Nine severe equinus deformities of the foot associated with extensive scarring of the leg and ankle were corrected using a hinged Ilizarov apparatus and free-tissue transfer. The average duration of followup was 38 months (range, 28-54 months). Free tissue transfer was done in all patients; a parascapular flap was used in seven patients, and a groin flap was used in two patients. The results were evaluated using two objective criteria and one subjective assessment: the degree of active dorsiflexion, the range of active movement of the ankle, and daily activities. For active dorsiflexion of the ankle and activities, the results were good in seven patients and fair in two patients. For range of active motion of the ankle, the results were good in six patients and fair in two patients. One patient with ankle arthrodesis was excluded. This study showed that severe equinus deformities associated with extensive scarring of the leg and ankle can be corrected effectively with heel cord lengthening, free-tissue transfer, and a hinged ilizarov technique. ( info)

4/22. Roberts syndrome, normal cell division, and normal intelligence.

    Roberts-SC phocomelia syndrome (RS) is an autosomal recessive disorder of symmetric limb defects, craniofacial abnormalities, pre- and postnatal growth retardation, and mental retardation. patients with RS have been reported to have premature separation of heterochromatin of many chromosomes and abnormalities in the cell-division cycle. No case has been reported who had normal intelligence and normal cell division with typical clinical features of the RS. We report a case of a six-year-old male of clinical and radiologic findings of typical RS with normal cell division and normal intelligence.Although he showed growth retardation, his intelligence was normal. Van Den Berg and Francke later reported that 79 out of 100 cases of Roberts syndrome had premature cell separation (PCS). We think that this case may demonstrate severe expression of the Roberts syndrome even though PCS is not exhibited. The limb involvement of this case was symmetrical, and he showed phocomelia of upper limbs, equinus valgus deformity of ankle, aplasia of fibula, and shortness of fifth toes while his hands and feet were normal with 5 rays each. craniofacial abnormalities of this case were typical; he showed scaphocephaly, mild hypertelorism, mandibular hypoplasia, dysplastic helix of ear, narrowing of external auditory canal, and cleft palate with wide gap.This report supports the theory that normal intelligence can make social-personal adjustment possible even if all of the stigmata of Roberts syndrome is present. ( info)

5/22. The effect of ankle equinus upon the diabetic foot.

    The association between ankle equinus and common foot pathologies such as Achilles tendinitis, metatarsalgia, Morton's neuroma, hallux abductovalgus, and plantar fasciitis has been described. However, the association between ankle equinus and diabetic foot pathology has only been recognized recently. Over half of the non-traumatic amputations occurring in the united states are related to complications of diabetes. It is imperative that risk factors for lower extremity ulceration and amputation are identified and addressed. This article reviews the effect of ankle equinus deformity on the diabetic foot and the available treatment options. New data on the prevalence of equinus in a population of patients with diabetes are also presented. ( info)

6/22. Long term course of the H reflex after selective tibial neurotomy.

    OBJECTIVES: This study was conducted to evaluate the long term clinical and electrophysiological outcome by recording the H reflex in a consecutive series of six patients treated by selective tibial neurotomy for spastic equinus foot. METHOD: The amplitudes of Hmax reflexes, Mmax responses, and Hmax:Mmax ratio were recorded in six patients with chronic lower limb spasticity, before and after surgery, at day 1 and 8 months and 24 months after selective tibial neurotomy. The passive range of movement, the stretch reflex score according to the Tardieu scale, the osteoarticular and tendon repercussions, and the quality of motor control of dorsiflexion were evaluated preoperatively and postoperatively. RESULTS: At the end of the study, all patients presented a reduction of equines. gait and Tardieu's score of spasticity had improved in all patients. Active dorsiflexion of the ankle was unchanged in four patients, but two improved by 5 degrees to 12 degrees. In five cases, fascicular resection of the superior nerve to soleus was, alone, sufficient to reduce spastic equinus foot, without recurrence, for a mean follow up of 28 months. Two patients were reoperated on, one for remaining spasticity related to an underestimated spasticity of the gastrocnemius muscles, and the other for painful claw toes. Hmax, Mmax, and Hmax:Mmax ratios were significantly lower the day after surgery. The reduction of Hmax and Hmax/Mmax ratio remained stable over time and was still statistically significant two years after the operation. However, the value of Mmax eight months postoperatively was no longer significantly different from the preoperative value. CONCLUSION: This study shows the long term efficacy of the selective tibial neurotomy as treatment of spastic equinus foot. Neurotomy confined to fibres supplying the soleus muscle is sufficient in most cases and acts by decreasing sensory afferents without significant long term motor denervation. ( info)

7/22. Ilizarov treatment for equinoplanovalgus foot deformity caused by melorheostosis.

    melorheostosis often is disabling because of progressive contracture of the joint and soft tissue involved. Operative intervention often is hazardous and patients also have recurrences. A 14-year, 2-month-old boy, who presented with a recurrent equinoplanovalgus deformity of the right foot caused by melorheostosis, was treated successfully using the ilizarov technique, including distraction osteotomy in the calcaneus. The patient had a painless, plantigrade, and functional foot at age 18 years. ( info)

8/22. Dokuz Eylul University (DEU) orthosis: an orthotic method of preventing ankle equinus during tibial lengthening.

    An orthosis developed in Dokuz Eylul University (DEU) at the School of Physical Therapy and rehabilitation, Department of Orthotics and Prostheticsis is described. It is applied as a non-invasive device attached to the distal ring of the Ilizarov external fixator to keep the ankle joint in a neutral position and prevent ankle equinus during tibial lengthening with ilizarov technique. This minimises additional invasive techniques such as heel cord release and prophylactic pinning of the heel and the foot, and manipulation under anaesthesia. It may also be detached by the physiotherapist or patient when physical therapy is needed during the lengthening procedure. ( info)

9/22. Toe-walking attributable to venous malformation of the calf muscle.

    Soft tissue venous malformations of muscles may produce musculoskeletal deformities caused by contracture of the involved muscle. When the venous malformation involves the flexor muscles of the leg, equinus deformity and toe-walking may occur. Three patients with unilateral toe-walking secondary to venous malformation of the calf muscle, showing the classic presentation of this unusual condition, are presented. Several methods of treating the deformity and the underlying venous malformation are discussed, and the current literature on intramuscular venous malformations, including their natural history, diagnoses, treatment options, and outcomes, is reviewed. Based on our experience and review of the literature, percutaneous sclerotherapy may be a viable option for treatment of venous malformations of the calf musculature that result in a toe-walking deformity. ( info)

10/22. Congenital diastasis of the inferior tibiofibular joint: report of three additional cases treated by the Ilizarov method and literature review.

    Congenital diastasis of the inferior tibiofibular joint presents clinical problems of talipes equinovarus, ankle diastasis, and leg-length inequality. In the past, foot disarticulation and prosthetic fitting has often been chosen as a solution because of the difficulty involved in functional reconstruction. The authors report three additional cases of congenital diastasis of the inferior tibiofibular joint that were satisfactorily treated by lengthening of the tibia and fibula and foot repositioning by the ilizarov technique. After treatment, all patients had a plantigrade, functional foot with normal sensation at skeletal maturity and were satisfied with the cosmetic and functional outcomes. The ilizarov technique is effective in accomplishing the goals of leg-length equalization and foot repositioning. ( info)
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