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The article offers step-by-step instructions for surgical treatment of severe cavovarus foot deformity in charcot-marie-tooth disease.

Introduction: Conservative therapy for bilateral spastic cerebral palsy (BSCP) regularly includes a modular orthosis setup with dynamic ankle-foot orthosis (DAFO) and modular shank supply (MSS). Additional effects by this modular supply have not been studied so far. The goal was thus an exploratory investigation of what effects can be expected by supplementing a DAFO with an additional MSS. Materials and Methods: Ten children with BSCP were fitted with DAFO and MSS. Dynamic elastic shank adaptations (DESAs) and ground reaction force AFOs (GRAFOs) were used, depending on the participants' individual needs. Participants underwent a gait analysis after supply and 3 months later. Data analysis included a descriptive analysis and further statistical testing using a Friedman test and post hoc Wilcoxon rank test. Results: The Gillette Gait Index (GGI) improved significantly with MSS compared with barefoot and DAFO, the Gait Deviation Index (GDI) only comparing DAFO to MSS. However, no further changes had occurred at follow-up, and for the Gait Profile Score (GPS), not at all. Step length, velocity, cadence, stance duration, and step width changed significantly after supply. Kinematic changes developed at ankle, knee, hip, and trunk. However, only minor changes had occurred at follow-up. Conclusions: DAFOs and MSS show positive effects, as observed in spatiotemporal parameters, gait indices, and kinematic data. Most kinematic effects occur at the ankle and knee joint. MSS produces additional effects, with a particular emphasis on the extending effect on the knee in terminal stance. Only minor beneficial effects on kinematic parameters of knee and trunk during swing phase occur after a familiarization phase. The changes in the spatiotemporal parameters imply a slight deterioration. [ABSTRACT FROM AUTHOR]

Background: Stiff gait resulting from rectus femoris dysfunction in cerebral palsy commonly is treated by distal rectus femoris transfer (DRFT), but varying outcomes have been reported. Proximal rectus femoris release was found to be less effective compared with DRFT. No study to our knowledge has investigated the effects of the combination of both procedures on gait.Questions/purposes: We sought to determine whether an additional proximal rectus release affects knee and pelvic kinematics when done in combination with DRFT; specifically, we sought to compare outcomes using the (1) range of knee flexion in swing phase, (2) knee flexion velocity and (3) peak knee flexion in swing phase, and (4) spatiotemporal parameters between patients treated with DRFT, with or without proximal rectus release. Furthermore the effects on (5) anterior pelvic tilt in both groups were compared.Methods: Twenty patients with spastic bilateral cerebral palsy treated with DRFT and proximal rectus femoris release were matched with 20 patients in whom only DRFT was performed. Standardized three-dimensional gait analysis was done before surgery, at 1 year after surgery, and at a mean of 9 years after surgery. Basic statistics were done to compare the outcome of both groups.Results: The peak knee flexion in swing was slightly increased in both groups 1 year after surgery, but was not different between groups. Although there was a slight but not significant decrease found the group with DRFT only, there was no significant difference at long-term followup between the groups. Timing of peak knee flexion, range of knee flexion, and knee flexion velocity improved significantly in both groups, and in both groups a slight deterioration was seen with time; there were no differences in these parameters between the groups at any point, however. There were no group differences in spatiotemporal parameters at any time. There were no significant differences in the long-term development of anterior pelvic tilt between the groups.Conclusions: The results of our study indicate that the short- and long-term influences of adding proximal rectus femoris release on the kinematic effects of DRFT and on pelvic tilt in children with cerebral palsy are negligible.Level Of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: With cerebral palsy (CP), an equinus deformity may lead to genu recurvatum. Botulinum toxin A (BtA) injection into the calf muscles is a well-accepted treatment for dynamic equinus deformity. Questions/purposes: The purpose of this study was to determine whether BtA injections into the calf muscles to decrease equinus would decrease coexisting genu recurvatum in children with diplegic CP. Methods: In a retrospective study, 13 children (mean age, 5 years) with spastic diplegic CP showing equinus and coexisting primary genu recurvatum, who were treated with BtA injections into the calf muscles, were included. Evaluations were done before and 6 and 18 weeks after intervention using three-dimensional gait analysis and clinical examinations according to a standardized protocol. Basic statistical analyses (power analysis, ANOVA) were performed to compare genu recurvatum before treatment and at 6 and 18 weeks after injection with BtA. Results: During stance phase, maximum ankle dorsiflexion was increased substantially from −3.0° ± 14.3° before to 6.2° ± 14.2° 6 weeks after the injections. Despite this, with the numbers available, the amount of recurvatum in stance did not improve with treatment at either 6 or 18 weeks. There was significant improvement of knee hyperextension during stance phase of 6.2° between baseline and 18 weeks after BtA injection, but a genu recurvatum was still present in most patients. Conclusions: Despite improvement of ankle dorsiflexion after injection with BtA, genu recurvatum did not show relevant improvement at 6 or 18 weeks after injection with the numbers available. Because knee hyperextension remained in most patients, other factors leading to genu recurvatum should be taken into consideration. In addition, a botulinum toxin-induced weakness of the gastrocnemius may explain why recurvatum gait was not significantly reduced. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]