Evidence-Based Treatment for Feet Deformities in Children with Neuromuscular Conditions
Foot deformities are very common in neuromuscular diseases. In these conditions, the muscles themselves or their control by the nervous system are affected with subsequent spasticity, weakness or both. In general, spasticity is a result of an upper motor
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Emmanouil Morakis and Anne Foster
Abstract
Foot deformities are very common in neuromuscular diseases. In these conditions, the muscles themselves or their control by the nervous system are affected with subsequent spasticity, weakness or both. In general, spasticity is a result of an upper motor neurons injury (e.g. cerebral palsy). Weakness commonly develops in injuries of the lower motor neurons (e.g. Charcot-Marie-Tooth disease). Muscles imbalance because of spasticity, weakness, or both can lead to the development of foot deformities. These can take the form of equinus, varus, valgus, cavus, planus or combinations of these. In this chapter we summarised the common foot deformities encountered in clinical practice with particular reference to cerebral palsy (CP) and spina bifida. Charcot-Marie-Tooth disease (CMT) is covered in chapter. Keywords
Foot deformities • Neuromuscular diseases • Cerebral palsy • Equinus • Cavo-varus • Planovalgus • Equino-valgus • Cavus • Planus • Spina bifida
Introduction Cerebral palsy has been defined as “group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior; by epilepsy, and by secondary musculoskeletal problems” [1]. Cerebral palsy can be classified according to the main movement disorder, the topographical distribution and the gross motor function. The most common movement disorder is the spastic type followed by the dyskinetic and mixed types. Less common forms include the ataxic and hypotonic. Topographical involvement in a patient differentiates into E. Morakis (*) • A. Foster Royal Manchester Children’s Hospital, Manchester, UK e-mail: [email protected]; [email protected]
monoplegia, hemiplegia, diplegia, triplegia and quadriplegia. Often differentiation between diplegia and quadriplegia can be difficult. The Gross Motor Function Classification System (GMFCS) distinguishes five levels of motor function with decreasing level of function and independent walking and increasing use of assistive devices [2]. It has been found to be valid, reliable, useful and stable over time [3]. Abnormal tone, spasticity, muscle imbalance and impaired motor control create a dynamic deformity of the foot. Over time, the development of soft tissue contractures, bone deformities and joint instability transforms the flexible deformity into a rigid one [4]. Most patients with cerebral palsy will develop a flexible or rigid deformity of their feet [5]. The most common foot deformities in patients with cerebral palsy include equinus, equino-plano-valgus and equino-cavo-varus [5]. Foot deformity in children with cerebral palsy can cause pain with ambulation, orthosis intolerance and frequent tripping. It also affects their standing and walking ability. It causes gait dysfunction, as the
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