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A preliminary evaluation of gait changes after orthopaedic surgery in adolescents with Charcot‐Marie‐Tooth
Author(s) -
G ACSADI,
H GRAHAM
Publication year - 2017
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.10_13512
Subject(s) - tooth disease , gait , orthopedic surgery , medicine , physical medicine and rehabilitation , physical therapy , orthodontics , surgery , disease
Background and Objective(s): Charcot-Marie-Tooth (CMT) is an inherited peripheral neuropathy and affects 1 in 2500 people in the USA [1]. The resulting muscle weakness and foot deformity have implications on ankle function during gait [2]. Orthopaedic surgical intervention is warranted in many patients for a variety of reasons including foot pain, ankle instability, orthosis fitting and shoe issues. The possible impact of these surgeries on ankle kinematic and kinetic function during gait is not known. Therefore, the goal of this study was to measure gait changes in ankle function due to surgical intervention in adolescents with CMT. Study Design: Retrospective review. Study Participants & Setting: A convenience sample of fourteen patients (10 4y at analysis 1 and 14 5y at analysis 2) with a diagnosis of CMT who had orthopaedic surgery (23 sides) were analyzed in a tertiary center. All sides had a plantar fascia release plus a combination of other soft-tissue (extensor hallicus longus, peroneus longus, and/or anterior tibialis transfers; and/or posterior tibialis lengthening) and/or bony procedures (metatarsal and/or cuboid osteotomies). Materials/Methods: This study protocol was approved by the institutional review board. All patients completed two gait analyses (one pre and one post-surgery) during barefoot walking using 3D motion analysis techniques following a standardized protocol [3]. The changes in ankle kinematics and kinetics and temporal spatial parameters were analyzed in reference to typically developing (TD) age matched controls. Paired t-tests were used to assess the changes in ankle function due to surgery between the two motion analysis assessments (p<0.05). Results: There was a mean of 3.8 years between the two gait analysis assessments. Patients showed a significant increase in stature between the pre and post-operative gait analyses but no changes were noted in temporal spatial and ankle function during gait (Table 1). Conclusions/Significance: Despite showing a significant increase in height, the patients in this study did not show any changes in the temporal and stride parameters after surgery (which remained less than in TD). This is consistent with our natural history data of patients with CMT over 2 years. The ankle kinematics and kinetics showed no statistically significant changes as a result of surgery. Peak ankle dorsiflexion which is most likely to be impacted by the plantar fascia release showed an increase in 10 sides, no change in 6 and a decrease in 7 sides. The results show that surgical intervention that primarily addresses foot alignment does not negatively impact ankle kinematics and kinetics during gait. Patients should be counseled that surgeries designed to improve foot position and comfort may not improve gait efficiency.