Is the Prevalence of Equinus Foot in Cerebral Palsy Overestimated? Results from a Meta-Analysis of 4814 Feet

Horsch, Axel; Klotz, Matthias; Platzer, Hadrian; Seide, Svenja; Zeaiter, Nancy; Ghandour, Maher

doi:10.3390/jcm10184128

Cited by 15 publications

(8 citation statements)

References 41 publications

(121 reference statements)

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“…Plantarflexion contracture of the ankle (equinus) is a frequent complication of spastic and paralytic NMDs (93% prevalence of equinus foot in spastic CP) [90] . If implemented early and consistently, active and passive stretching of the gastroc-soleus complex significantly improves ankle dorsiflexion range [91].…”

Section: Management Of Ankle Contracturesmentioning

confidence: 99%

Management of arthrofibrosis in neuromuscular disorders: a review

Martinez-Lozano

Beeram

Yeritsyan

et al. 2022

BMC Musculoskelet Disord

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Arthrofibrosis, or rigid contracture of major articular joints, is a significant morbidity of many neurodegenerative disorders. The pathogenesis depends on the mechanism and severity of the precipitating neuromuscular disorder. Most neuromuscular disorders, whether spastic or hypotonic, culminate in decreased joint range of motion. Limited range of motion precipitates a cascade of pathophysiological changes in the muscle-tendon unit, the joint capsule, and the articular cartilage. Resulting joint contractures limit functional mobility, posing both physical and psychosocial burdens to patients, economic burdens on the healthcare system, and lost productivity to society. This article reviews the pathophysiology of arthrofibrosis in the setting of neuromuscular disorders. We describe current non-surgical and surgical interventions for treating arthrofibrosis of commonly affected joints. In addition, we preview several promising modalities under development to ameliorate arthrofibrosis non-surgically and discuss limitations in the field of arthrofibrosis secondary to neuromuscular disorders.

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Section: Management Of Ankle Contracturesmentioning

confidence: 99%

Management of arthrofibrosis in neuromuscular disorders: a review

Martinez-Lozano

Beeram

Yeritsyan

et al. 2022

BMC Musculoskelet Disord

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“…The characteristics of equinus were not clearly identified. Therefore, we determined dynamic equinus at ankle dorsiflexion less than 10 degrees [44] instead of unreliable passive range of motion [10]. Furthermore, the outcomes were evaluated at a short period of 3-4 months, but it was adequate to detect gait improvement [23].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of conservative treatment for spastic cerebral palsy children with equinus gait: a systematic review and meta-analysis

et al. 2022

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Background Comparisons between various conservative managements of spastic equinus deformity in cerebral palsy demonstrated limited evidences, to evaluate the efficacy of conservative treatment among cerebral palsy children with spastic equinus foot regarding gait and ankle motion. Methods Studies were identified from PubMed and Scopus up to February 2022. Inclusion criteria were randomized controlled trial (RCT), conducted in spastic cerebral palsy children with equinus deformity, aged less than 18 years, compared any conservative treatments (Botulinum toxin A; BoNT-A, casting, physical therapy, and orthosis), and evaluated gait improvement (Physician Rating Scale or Video Gait Analysis), Observational Gait Scale, Clinical Gait Assessment Score, ankle dorsiflexion (ankle dorsiflexion at initial contact, and passive ankle dorsiflexion), or Gross Motor Function Measure. Any study with the participants who recently underwent surgery or received BoNT-A or insufficient data was excluded. Two authors were independently selected and extracted data. Risk of bias was assessed using a revised Cochrane risk-of-bias tool for randomized trials. I2 was performed to evaluate heterogeneity. Risk ratio (RR), the unstandardized mean difference (USMD), and the standardized mean difference were used to estimate treatment effects with 95% confidence interval (CI). Results From 20 included studies (716 children), 15 RCTs were eligible for meta-analysis (35% had low risk of bias). BoNT-A had higher number of gait improvements than placebo (RR 2.64, 95% CI 1.71, 4.07, I2 = 0). Its combination with physical therapy yielded better passive ankle dorsiflexion at knee extension than physical therapy alone (USMD = 4.16 degrees; 95% CI 1.54, 6.78, I2 = 36%). Casting with or without BoNT-A had no different gait improvement and ankle dorsiflexion at knee extension when compared to BoNT-A. Orthosis significantly increased ankle dorsiflexion at initial contact comparing to control (USMD 10.22 degrees, 95 CI% 5.13, 15.31, I2 = 87%). Conclusion BoNT-A and casting contribute to gait improvement and ankle dorsiflexion at knee extension. BoNT-A specifically provided gait improvement over the placebo and additive effect to physical therapy for passive ankle dorsiflexion. Orthosis would be useful for ankle dorsiflexion at initial contact. Trial registration PROSPERO number CRD42019146373.

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“…Among these individuals, the prevalence rate of equinus is 83% 19 to 93%. 20 Because of a spastic increase in muscle tone, individuals show a spastic dynamic contracture triceps surae muscle resulting in a restricted range of motion (ROM) of the ankle. 4 Also, spasticity can be the result of the loss in the corticospinal tract innervation, which can subsequently result in smaller muscle size, reduced strength, and an increase in connective tissue.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Operative Correction of Equinus in Cerebral Palsy on Gait Patterns

Horsch,

Petzinger,

Deisenhofer

et al. 2023

Foot Ankle Int.

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Background: This study aimed to evaluate gait outcomes and strength following the surgical correction of equinus in cerebral palsy (CP) based on different surgical procedures. We included the Baumann and Strayer procedures, as well as the Achilles tendon lengthening (ATL). Methods: A retrospective analysis was performed in patients with infantile, bilateral CP who received instrumental 3D gait analysis before and after surgical correction (18.66 months postoperatively). Patients were divided into 3 groups: Strayer surgery, Baumann surgery, and ATL. Gait performance and muscle strengths were compared between studied surgeries. Results: A total population of 204 patients (15.43 years) with 341 operated lower limbs (LLs) was analyzed. Dorsiflexion in swing and stance phases significantly improved in all groups postoperatively. The Strayer and the ATL group showed higher postoperative dorsiflexion than the Baumann group. However, no loss of strength was observed with the Baumann method. Maximum power improved in this group postoperatively. An 8.2% loss in calf muscle strength was recorded in the Strayer group. Conclusion: Operative pes equinus treatment successfully improved the gait of children and adults with CP postoperatively. There were differences in postoperative results between studied operative techniques regarding range of motion and power. Level of Evidence: Level III, retrospective cohort study.

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Is the Prevalence of Equinus Foot in Cerebral Palsy Overestimated? Results from a Meta-Analysis of 4814 Feet

Cited by 15 publications

References 41 publications

Management of arthrofibrosis in neuromuscular disorders: a review

Management of arthrofibrosis in neuromuscular disorders: a review

Efficacy of conservative treatment for spastic cerebral palsy children with equinus gait: a systematic review and meta-analysis

The Impact of Operative Correction of Equinus in Cerebral Palsy on Gait Patterns

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