Treatment of the Lower Extremity Contracture/Deformities

Abstract

Lower extremity deformities of patients with arthrogryposis multiplex congenita present a wide spectrum of severity and deformity combinations. Treatment goals range from merely ensuring comfortable seating and shoe wear, to fully independent and active ambulation, but the overarching intention is to help realize the patient's greatest potential for independence and function. Treatment of hip and knee contractures and dislocations has become more interventional, whereas treatment of foot deformities has paradoxically become much less surgical. This article synopsizes the treatment strategies presented in September 2014 in Saint Petersburg, Russia at the second international symposium on arthrogryposis.

Treatment and outcomes of arthrogryposis in the lower extremity

“…The most common deformity is severe clubfoot, with a reported incidence of up to 90% (Figure ). Other deformities include congenital vertical talus (CVT; 3–10%) and, less often, isolated equinus, cavovarus, equinovalgus, metatarsus adductus, and calcaneovalgus (Bevan et al, ; Guidera & Drennan, ; Sodergard & Ryoppy, ; van Bosse et al, ). The clubfoot deformity can be divided to “classic variant” and equinocavus variant.…”

“…The clubfoot deformity can be divided to “classic variant” and equinocavus variant. In equinocavus variant, equinus and midfoot cavus are the main deformities, whereas heel varus, supination of the forefoot, and adductus are very mild (this deformity looks like “atypical” clubfoot; van Bosse, ; van Bosse et al, ). The difference between syndromic and similar idiopathic deformities is probably the time they formed while in utero (van Bosse, ).…”

Rehabilitation across the lifespan for individuals with arthrogryposis

“…Connective tissues are most compliant shortly after birth and early manipulation may provide an opportunity for a somewhat “typical” joint to form (van Bosse et al, ). Because the anatomical alignment is often a challenge to discern, gentle passive ROM is performed with mindfulness of optimal alignment.…”

“…The older infant will use strong core muscles, learning to find their center of gravity to balance over the base of support. With the help of custom molded orthotics, the older infant will have the foundation to succeed with balanced standing and future walking (van Bosse et al, ).…”

Perspectives on gait and motion analysis in the management of youth with arthrogryposis multiplex congenita

“…While the discussion of the benefits of QGA for lower limb management has focused on the role of gait analysis in the optimization of orthoses for gait function in youth with AMC, the principles detailed in the section above could apply to assessing presurgical gait analysis and postsurgical patient functional outcomes. Clubfoot deformities, knee contractures and hip dislocations are the most common orthopedic deficits reported in AMC (Van Bosse et al, ) and are most likely to affect gait patterns in youth with AMC. Surgical management of the lower limbs are frequent in AMC with 76% of children undergoing foot surgery, 39% knee surgery and 16% hip surgery (Bamshad, Van Heest, & Pleasure, ) and QGA could contribute to understanding the efficiency of surgeries in restoring partial function of the lower limbs.…”