Orthopaedic Management in Down Syndrome

Rako, Kyle; Ranade, Sheena; Allen, Abigail K

doi:10.55275/jposna-2021-283

Cited by 4 publications

(6 citation statements)

References 80 publications

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“…3 Commonly reported foot deformities in DS are pesplanovalgus, hallux valgus, increased space between the first and second toes (sandal gap), syndactyly, clinodactyly, and metatarsus adductus. 1,3,5,7 Pesplanovalgus or flatfoot is commonly reported in DS, with incidence ranging from 60% to 91% in different studies. 1,3,6 Clubfoot in DS is less reported.…”

Section: Discussionmentioning

confidence: 99%

“…1 Hypotonia, joint laxity, increased Body Mass Index(BMI), and ankle instability contribute to most orthopedic problems associated with DS. [1][2][3][4][5][6] Twenty percent of all DS have orthopedic problems; among them, 60-91% have pesplanovalgus. 1,3,6,7 Other orthopedic manifestations in DS are scoliosis, atlanto-axial instability, hip subluxation, slipped capital femoral epiphysis, Legg-Calve-Perthes disease, and patellar instability, and in the foot other than pesplanovalgus hallux valgus, syndactyly, clinodactyly.…”

Section: Introductionmentioning

confidence: 99%

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A Rare Combination of Clubfoot and Down Syndrome: A Case Series and Literature Review

Gurung

2024

NOAJ

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Down syndrome (DS) is commonly associated with pesplanovalgus among foot disorders due to hypotonia and joint laxity. Soft tissue contractures around the ankle and foot are implicated as the pathoanatomy in the case of Clubfoot, which is different from DS. Few cases of Clubfoot have been reported in association with DS. We report two cases of Clubfoot in association with DS, which were treated with the ponseti method and gave a good result. Keywords: clubfoot, CTEV, case report, downs syndrome, hyperlaxity

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Rare Combination of Clubfoot and Down Syndrome: A Case Series and Literature Review

Gurung

2024

NOAJ

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“…Greater motor impairment leads to less bearing and movement, resulting in reduced reaction forces at the hip during development, thereby predisposing patients to morphologic alterations of the proximal femur and acetabulum. Furthermore, hip instability can result in progressive loss of mobility and function 22…”

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confidence: 99%

“…Furthermore, hip instability can result in progressive loss of mobility and function. 22 The relationship between functional level and hip dysplasia in DS has not been studied thus far. However, we hypothesize that there may be a relationship between these 2 variables.…”

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confidence: 99%

Is There a Relationship Between the Functional Level of Juvenile and Adolescent Patients With Down Syndrome and Hip Dysplasia?

Galán-Olleros

Palazón-Quevedo

Egea-Gámez

et al. 2023

Journal of Pediatric Orthopaedics

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Background: The prevalence of hip dysplasia among patients with Down syndrome (DS) is higher than in the general population. We hypothesize that a relationship may exist between functional level and hip dysplasia in DS, but this has not been studied to date. The aim of this study is to evaluate whether there is a relationship between functional level and radiographic parameters of hip dysplasia or other measures. Methods: Retrospective cross-sectional comparative study of 652 patients with DS from a pediatric referral center database. Patients over 8 years of age with an anteroposterior pelvis radiograph and with no exclusion criteria were selected, totaling 132 patients (264 hips; 54.55% females; mean age 12.96 ± 2.87 y). Several radiographic parameters of the acetabulum [Sharp angle (SA), Tönnis angle (TA), Wiberg center-edge angle (W-CEA), extrusion index (EI), and acetabular retroversion signs], the proximal femur [neck shaft angle (NSA)], and joint congruence [Shenton line (SL)] were assessed. Patients were classified into 2 levels based on functional skills. A multivariate association analysis was performed between radiographic parameters and functional level. Results: Sixty-one patients were compatible with a functional level I and 71 with a level II. Forty-six hips were dysplastic and 60 were borderline according to the W-CEA. A statistically significant relationship was found between the categorical distribution of certain radiographic measurements of hip dysplasia (EI, SA, TA, W-CEA, SL, and classification by functional level (P < 0.0005). A significant receiver operating characteristic curve was obtained for W-CEA with a cutt-off point at 26.4 degrees for level I (area under the curve = 0.763; P < 0.005; sensitivity = 0.800 and specificity = 0.644). There was a fairly high correlation between EI and TA (0.749; P < 0.0005), EI and W-CEA (−0.817; P < 0.0005), and TA and W-CEA (−0.748; P < 0.0005). Numerous hips showed signs of acetabular retroversion, with no significant differences found between functional levels or association with hip dysplasia measures. Conclusions: The present study reveals a relationship between an increased risk of hip dysplasia and reduced functional levels in DS children older than 8 years. These findings may guide individualized clinical follow-up of hip development in DS children considering their functional level. Level of Evidence: Level III, retrospective comparative study.

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“…Foot abnormalities can also result in difficulties such as discomfort while wearing shoes and decreased ambulation. 4 In most cases, PVF in child patients with DS is only treated with shoe insoles or orthoses with arch supports 5 and no close follow-up. Very little has been published on the natural history and treatment of PVF in DS patients, 4 although this manifestation is known to persist usually into adulthood.…”

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confidence: 99%

Long-term Impact of Planovalgus Foot on Activities of Daily Living in Patients With Down Syndrome

Galán-Olleros

Ramírez-Barragán

Rodríguez-Zamorano

et al. 2023

Journal of Pediatric Orthopaedics

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Introduction: Planovalgus foot (PVF) is the most common orthopaedic abnormality in children with Down syndrome (DS), and as a result these patients rarely develop an adequate plantar arch in adulthood. The present study aims to evaluate the impact of PVF on activities of daily living and participation in sports among young adults with DS and determine whether this impact is related to the degree of foot deformity based on clinical and imaging studies. Methods: Observational analytical study examining a database of 649 patients with DS from a pediatric referral center, identifying those individuals over age 20 years at the time of the study with a childhood diagnosis of PVF. Finally, 51 patients (102 feet) were evaluated based on clinical and imaging studies, and function was assessed using the The Foot and Ankle Outcome Score (FAOS) and the Visual Analogue Scale (VAS) pain scale. A correlation analysis was performed to determine the clinical and radiographic variables associated with functional outcomes. Linear regression models were obtained to quantify the impact of these variables on function. Results: Patients had a mean age of 26.14±3.88 years and body mass index of 24.51±4.57. Clinically, 63.65% presented grade 3 or 4 PVF, and most were flexible. Radiographically, midfoot flattening was mild-moderate in 92.16%, 58.82% had medial talo-navicular uncoverage, and 30.39% had an increased hallux valgus (HV) angle. Mean scores for all FAOS subscales were between 65 and 71% and the mean VAS score was 1.45±1.96. An association analysis revealed a tendency toward lower scores on all FAOS subscales and greater pain according to the VAS scale in more severe PVF and in cases of moderate HV with asymmetry between feet. Linear regression models showed that major contributors to functional scores were radiographic evidence of hindfoot valgus, midfoot abduction, and flattening, and HV. Conclusions: Young adults with DS who are diagnosed with PVF in childhood have acceptable functional scores and low pain. Alteration of radiographic parameters toward flatter, more valgus and abducted feet and greater and asymmetric HV tend to be associated with worse long-term functional scores in activities of daily living and sports participation and increased pain. Therefore, non-operative management of these patients is justified, although individualized treatment is recommended. Level of Evidence: Level IV, Case series.

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Orthopaedic Management in Down Syndrome

Cited by 4 publications

References 80 publications

A Rare Combination of Clubfoot and Down Syndrome: A Case Series and Literature Review

A Rare Combination of Clubfoot and Down Syndrome: A Case Series and Literature Review

Is There a Relationship Between the Functional Level of Juvenile and Adolescent Patients With Down Syndrome and Hip Dysplasia?

Long-term Impact of Planovalgus Foot on Activities of Daily Living in Patients With Down Syndrome

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