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Topic:

Clubfoot

Issue:

Foot

Category:

Congenital

Title:

Neuromuscular Dysfunction in Clubfeet Associated With Constriction Band Syndrome

Author:

Starcevich, Ana G. MS; Demetri, Leah R.F. MD; James, Michelle A. MD; Lerman, Joel A. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

March 2024

Reference:

44(3): p 184-187, DOI: 10.1097/BPO.0000000000002587

Level Of Evidence:

IV

# of Patients:

20 children with 26 clubfeet

Study Type:

Retrospective case series

Location:

Not specified

Summary:

This study investigates the association between clubfoot and neuromuscular dysfunction (NMD) in patients with constriction band syndrome (CBS), as well as the impact of NMD on treatment outcomes.

Methods:

Inclusion Criteria: Patients with CBS and clubfoot treated with the Ponseti method, at least 1 year of follow-up, and detailed physical exams describing lower extremity neuromuscular function and constriction bands. Intervention: Ponseti method for clubfoot treatment. Outcome Measures: Presence and location of constriction bands Neuromuscular function (presence of absent ankle dorsiflexion) Treatment and outcomes (number of casts, relapses, surgical procedures, and use of AFO beyond age 4)

Exclusions:

Not specified

Results:

Neuromuscular Dysfunction (NMD): 46% of clubfeet (12/26) had NMD (absent ankle dorsiflexion). Constriction Bands: Clubfeet with and without NMD had similar rates of ipsilateral thigh or leg constriction bands (42% vs. 43%, P=0.106). However, the majority of NMD clubfeet (7/12) did not have ipsilateral thigh or leg constriction bands. Treatment Outcomes: NMD clubfeet tended toward more casts, relapses, and surgical procedures than those without NMD, but these differences were not statistically significant. A higher percentage of NMD clubfeet required daytime AFO use beyond age 4 (58% vs. 14%, P=0.04).

Conclusions:

Clubfeet with NMD can occur without proximal constriction bands, suggesting that the neuromuscular dysfunction may not be directly caused by visible constriction bands. These findings imply that other mechanisms, beyond direct nerve damage from constriction bands, may contribute to NMD in CBS patients. While NMD clubfeet tended to require more casts, relapses, and surgeries, these differences were not statistically significant. Children with NMD in clubfeet may require long-term use of daytime AFOs, particularly beyond age 4.

Relevance:

Limitations:

Perspective:

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