Equinus and Lengthening Techniques

DeHeer, Patrick A.

doi:10.1016/j.cpm.2016.10.008

Cited by 21 publications

(15 citation statements)

References 141 publications

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“…For instance, as mentioned previously, a dorsiflexion position at the ankle coupled with an inverted subtalar position (knee extended) can enhance the effect of the maneuver on GM compared with other plantar flexors (18). In addition, when severe contractures are noticeable, release surgeries are offered to survivors to restore ankle joint dorsiflexion (13). However, secondary mobility issues related to such surgery have been observed, including overlengthening of the muscles (1).…”

Section: Discussionmentioning

confidence: 99%

Effects of stroke injury on the shear modulus of the lower leg muscle during passive dorsiflexion

Sant

Nordez

Hug

et al. 2019

Journal of Applied Physiology

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Le Sant G, Nordez A, Hug F, Andrade R, Lecharte T, McNairPJ, Gross R. Effects of stroke injury on the shear modulus of the lower leg muscle during passive dorsiflexion. Contractures are common complications of a stroke. The spatial location of the increased stiffness among plantar flexors and its variability among survivors remain unknown. This study assessed the mechanical properties of the lower leg muscles in stroke survivors during passive dorsiflexions. Stiffness was estimated through the measurement of the shear modulus. Two experiments were independently conducted, in which participants lay supine: with the knee extended (experiment 1, n ϭ 13 stroke survivors and n ϭ 13 controls), or with the knee flexed at 90°(experiment 2, n ϭ 14 stroke survivors and n ϭ 14 controls). The shear modulus of plantar flexors [gastrocnemius medialis (three locations), gastrocnemius lateralis (three locations), soleus (two locations), flexor digitorum longus, flexor hallucis longus), peroneus longus] and dorsiflexors (tibialis anterior and extensor digitorum longus) was measured using ultrasound shear wave elastography during passive dorsiflexions (2°/s). At the same ankle angle, stroke survivors displayed higher shear modulus than controls for gastrocnemius medialis and gastrocnemius lateralis (knee extended) and soleus (knee flexed). Very low shear modulus was found for the other muscles. The adjustment for muscle slack angle suggested that the increased shear modulus was arising from consequences of contractures. The stiffness distribution between muscles was consistent across participants with the highest shear modulus reported for the most distal regions of gastrocnemius medialis (knee extended) and soleus (knee flexed). These results provide a better appreciation of stiffness locations among plantar flexors of stroke survivors and can provide evidence for the implementation of clinical trials to evaluate targeted interventions applied on these specific muscle regions. NEW & NOTEWORTHYThe shear modulus of 13 muscle regions was assessed in stroke patients using elastography. When compared with controls, shear modulus was increased in the gastrocnemius muscle (GM) when the knee was extended and in the soleus (SOL) when the knee was flexed. The distal regions of GM and SOL were the most affected. These changes were consistent in all the stroke patients, suggesting that the regions are a potential source of the increase in joint stiffness.

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Section: Discussionmentioning

confidence: 99%

Effects of stroke injury on the shear modulus of the lower leg muscle during passive dorsiflexion

Sant

Nordez

Hug

et al. 2019

Journal of Applied Physiology

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“…In that regard, the integrity of the myofascial extensions and the sound healing of the severed aponeurosis are beneficial [19,20]. Contrastingly, the distal Achilles tenotomy is believed to have more deleterious and unanticipated impact on the gastrocsoleus muscle function and biomechanics, especially the push-off strength [1,5,6]. These effects are more pronounced in diplegic/bilateral CP children.…”

Section: Discussionmentioning

confidence: 99%

“…Ankle equinus is one of the extremely prevalent deformities in cerebral palsy (CP) children [1]. Equinus contracture is best remedied by lengthening of the triceps surae/gastrocnemius–soleus (gastrocsoleus) complex.…”

Section: Introductionmentioning

confidence: 99%

“…Equinus contracture is best remedied by lengthening of the triceps surae/gastrocnemius–soleus (gastrocsoleus) complex. Numerous triceps surae lengthening procedures are described in the literature [1,2]. They have been classified in accordance with three distinct anatomic zones of the triceps surae complex.…”

Section: Introductionmentioning

confidence: 99%

“…Silfverskiöld’s test plays a pivotal role in differentiating gastrocnemius-induced contracture from combined gastrocsoleus-induced contracture. Nonetheless, it is commonly overlooked by physicians [1,6].

Figure 1Zone one (proximal) of the triceps surae complex.…”

Section: Introductionmentioning

confidence: 99%

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Current practice and preferences to management of equinus in children with ambulatory cerebral palsy: A survey of orthopedic surgeons

Gendy¹,

ElGebeily

El-Sobky

et al. 2019

SICOT-J

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Introduction: The consensus among orthopedic surgeons on the management of equinus deformity in cerebral palsy (CP) children has not been reported previously despite being a prevalent deformity. The goals of this study were to examine the orthopedic surgeons’ current practice regarding the management of equinus deformity in children with ambulatory CP, and analyze variations in current practice between general orthopedic and pediatric orthopedic surgeons. Methods: We implemented a brief cross-sectional self-reported questionnaire that addressed the areas of clinical examination and decision-making skills of management of equinus deformity in CP children. We targeted a convenience sample of 400 participants. Surgeons that provided complete responses to the questionnaire were 223 with a response rate of 56%, of which 123 (55%) were general orthopedic surgeons, whereas 100 (45%) were pediatric orthopedic surgeons. The target population consisted of orthopedic surgeons who were further sub-classified in accordance with practice age, general versus pediatric, and exposure to children’s orthopedics during the last three years of their practice. For analytical statistics, the Chi-Square test and Fisher’s exact test were used to examine the relationship between two qualitative variables. Results: The overall clinical practice preferences of all survey participants were unimpressive with discordant survey responses. Pediatric orthopedic surgeons generally demonstrated a statistically significant difference regarding clinical assessment skill items of the survey, in contrast to general orthopedic surgeons. However, we found no differences between pediatric orthopedic and general orthopedic surgeons regarding most of the decision-making/knowledge items. Discussion: Generally, there are insufficient clinical practice trends of both general and pediatric orthopedic surgeons regarding equinus treatment in CP children. This may indicate a knowledge–practice gap with potential risks to CP children undergoing surgery for equinus. There is a need for a more competent exposure to CP in orthopedic surgeons’ educational curricula and an updated health referral system.

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