Description

Surgery Can Return Function To The Impaired Lower Leg

All too often, bracing is considered the best or the only option for those with Neuromuscular Imbalance affecting the lower leg. Drop foot, spastic or fixed equinas, cavo-varus deformities, and hammered toes present significant ambulatory challenges. Ankle foot orthoses and bulky functional braces keep patients confined to special shoes and/or unsightly devices. According to Dr. Kenneth M. Leavitt, patients with Cerebral Palsy, Charcot-Marie-Tooth Disese, Post-Polio deformities, or "drop foot" paralysis are conditions that can be freed from the need for bracing and Orthotics.

C-M-T-D Example

Charcot-Marie-Tooth Disease, as described simultaneously by Tooth in England and Charcot and Marie in France in the late 1800's, is a dominantly inherited demyelinating hypertrophic europathy involving peripheral nerves. Onset will most often occur in late childhood. Progression slows in the late teen years and may stop altogether. Bilateral peripheral distal muscular atrophy with resultant neurologic weakness begins in the feet and legs and later involves the hands and distal aspects of the arts. In the leg and foot, the anterior (front) musculature is the first to be affected. Resultant posterior muscle dominance causes a series of progressive deformities; pes cavovarus or equinovarus deformities and contractures of the toes. Two thirds of all patients who seek treatment for symptomatic high-arch feet, ankle equinas and digital deformities will have an underlying neurological problem, and half of these will have CMTD.

Early Stage Intervention

In the early stages of the disease, before rigid joint and soft-tissue deformities set in, Dr. Leavitt can perform surgery to release soft tissue, lengthen tendons and reposition tendons to maintain a semblance of normal ambulatory function. Early surgical intervention is also helpful in reducing the long-term potential for rigid deformities, Leavitt said.

Late Stage Treatment

In late stage treatment, rigid deformities (the cavus or high arch, the "hammer toes" and the heel varus) are corrected with soft-tissue releases, osteotomies and/or joint fusions, and then combined with appropriate tendon procedures, Leavitt explained. In cases of severe anterior compartment weakness and drop foot, the transfer of the tibialis posterior to the dorsum of the foot, through the interosseus membrane is very effective.

Competing Philosophies

Surgical mismanagement of those with lower extremity neurological manifestations have very often drawn practitioners into competing philosophical camps, Leavitt said. Those opposed to surgery have too often seen their patients suffer poor results usually due to poor decisionmaking. Leavitt is convinced that, although surgery is not a panacea, a complete understanding of the disease and functional anatomy will help him plan appropriate surgical procedures that can often free patients to walk unassisted and free them from braces and orthotics.

Returning Function To the Impaired Lower Leg

Surgical Options

All too often, bracing is considered the best or only option for those with Neuromuscular Imbalance affecting the lower leg. Drop foot, spastic or fixed equinas, cavo-varus deformities, and hammered toes present significant ambulatory challenges. Ankle foot orthoses and bulky functional braces keep patients confined to special shoes and/or unsightly devices. Patients with Cerebral Palsy, Charcot-Marie-Tooth Disease, Post-Polio deformities to name a few conditions that affect muscle and joint function of the lower leg, can be freed from the need for bracing and orthotics.

Example: Charcot-Marie-Tooth Disease

Charcot-Marie-Tooth Disease ("CMTD"), as described simultaneously by Tooth in England and Charcot and Marie in France in the late 19th Century. CMTD is a dominantly inherited demyelinating hypertrophic neuropathy involving peripheral nerves. Onset will most often occur in late childhood. Progression slows in the late teen years and may stop altogether.

Bilateral peripheral distal muscular atrophy with resultant neurologic weakness begins in the feet and legs and later involves the hands and distal aspects of the arms. In the leg and foot,the anterior musculature is the first to be affected. Resultant posterior muscle dominance causes a series of progressive deformities; pes cavovarus or equinovarus deformities and contractures of the toes. Two thirds of all patients who seek treatment for symptomatic high-arch feet, ankle equinas and digital deformities will have an underlying neurological problem,and half of these will have CMTD.

In the early stages of the disease, before rigid joint and soft-tissue deformities set-in, soft-tissue releases, tendon lengthenings and tendon repositionings can be used effectively to maintain a semblance of normal ambulatory function. Early surgical intervention is also helpful in reducing the long-term potential for rigid deformities.

In late stage treatment, rigid deformities (the cavus or high arch, the "hammer toes" and the heel varus) are corrected with soft-tissue releases, osteotomies and/or joint fusions, and then combined with appropriate tendon procedures. In cases of severe anterior compartment weakness and drop foot, the transfer of the tibialis posterior to the dorsum of the foot, through the interosseus membrane is very effective.

Surgical mismanagement of those with lower extremity neurological manifestations have very often drawn practitioners at odds and into competing philosophical camps.Those opposed to surgery have too often seen their patients suffer poor results usually due to poor decision-making. Though surgery is not a panacea, a complete understanding of the disease and functional anatomy will help plan appropriate surgical procedures that can often free patients from difficult or assisted ambulation, and from braces and orthotics.