ABSTRACT
OBJECTIVE: Various underlying diseases can lead to a pointed foot in children and adults. If the gastrocnemius and soleus muscles are structurally shortened, various surgical procedures are available to correct this malposition. A preferred method for restoring a normal dorsiflexion of the upper ankle joint is percutaneous achillotentomy according to Hoke. Consideration of the physiological-anatomical torsion of the Achilles tendon as it corresponds to the White technique and is recommended by some authors shows in our experience no advantages. In the present work, we show a modified, likewise minimally invasive form of this surgical method with which immediate full weight-bearing of the affected lower extremity is possible from postoperative day 1. INDICATIONS: All clinically relevant structural pointed foot, for primary and/or for revision treatment. CONTRAINDICATIONS: Infection in the area of the operation. SURGICAL TECHNIQUE: No tourniquet, 3 incisions with the 15â¯mm knife: (1) medial distal at the transition from the Achilles tendon to the calcaneus, (2) medial proximal approximately 7â¯cm proximal to the 1st stab incision, (3) lateral, midway between the first two incisions; no skin suturing, application of a lower leg cast. POSTOPERATIVE MANAGEMENT: On postoperative day 1, cast hybridization using Scotchcast (3M Deutschland GmbH, Neuss, Germany), followed by pain-adapted full weight-bearing; removal of the cast in the outpatient department after 4 weeks. RESULTS: A total of 104 patients underwent surgery, 1 case of a local pressure point, no infections, no overcorrections, no Achilles tendon ruptures, in one case a postoperative relapse due to a broken cast. The risk of overcorrection to the foot, which was considered the main complication in the literature, did not occur in any of the cases.
Subject(s)
Achilles Tendon , Achilles Tendon/surgery , Adult , Child , Foot , Humans , Lower Extremity , Minimally Invasive Surgical Procedures , Rupture , Tenotomy , Treatment OutcomeABSTRACT
Objective To explore the clinical curative effect of electromyographic biofeedback on pointed foot in children with spastic cerebral palsy. Methods From June, 2014 to December, 2015, 80 children with spastic cerebral palsy and pointed foot were divided into con-ventional group (n=40) and electromyographic biofeedback group (n=40). The conventional group received exercise and massage, while the electromyographic biofeedback group received electromyographic biofeedback in addition. The passive range of motion (PROM) of ankle, the surface electromyographic results and the selective control results were compared before and eight weeks after treatment. Results After treatment, the PROM significantly decreased in both groups (t>9.142, P3.456, Z>3.178, P3.737, Z=-2.748, P<0.01). Conclusion Electromyographic biofeedback can further improve the foot dor-sal flexure and pointed foot gait of spastic cerebral palsy children.