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Assessment and management of the lower extremity in myelodysplasia
1Department of Orthopaedics, Northwestern University School of Medicine, Chicago, Illinois.
Insights
Managing lower extremity issues in children with spina bifida aims for near-normal development. Key interventions include surgery, therapy, and orthotics to correct deformities and improve mobility, emphasizing a multidisciplinary approach.
Area of Science:
- Pediatric Orthopedics
- Developmental Pediatrics
- Rehabilitation Medicine
Background:
- Spina bifida often leads to lower extremity deformities due to muscle imbalance, weight-bearing, and gravity.
- Associated conditions like hydrocephalus and neurological deficits contribute to developmental delays and affect mobility potential.
- Effective management requires addressing deformities, joint stability, and mobility in the context of the child's overall development.
Purpose of the Study:
- To outline the principles and goals of managing lower extremity development in children with spina bifida.
- To highlight the role of orthopedic interventions in correcting deformities and enhancing function.
- To emphasize the importance of a comprehensive, multidisciplinary approach to care.
Main Methods:
- Surgical correction of hip, knee, and foot deformities to achieve stability and alignment.
- Application of orthotics, including braces and specialized footwear, to support correction and prevent complications.
- Gait training and physical therapy to optimize mobility and functional outcomes.
- Management of associated conditions impacting overall development and surgical success.
Main Results:
- Surgical interventions can correct deformities, improve joint stability, and enhance mobility.
- Proper orthotic care and therapy are crucial for maintaining surgical results and preventing skin breakdown.
- A coordinated team approach, integrating orthopedic surgery within a broader habilitative program, is essential for optimal outcomes.
Conclusions:
- Achieving near-normal lower extremity development in children with spina bifida requires a multifaceted strategy.
- Orthopedic surgery is a vital component but must be supported by consistent therapy and orthotic management.
- The ultimate goal is to maximize the child's potential for upright posture and functional mobility.
Abstract:
The goal in managing the lower extremity in a child with spina bifida is to achieve a pattern of development as near normal as possible. Lower limb deformities are produced by muscle imbalance, weight-bearing, and the postural effects of gravity. At any point in time, the management of the lower extremities will depend on the child's general development. Lower limb paralysis, hydrocephalus, bladder infections, hydromyelia, and Arnold Chiari malformation, all contribute to developmental delay. A child's potential for mobility varies with the severity of the motor and sensory deficit. Surgery is done to correct deformity, provide joint stability, and improve joint mobility. The results of surgery will be compromised if the child is not neurologically stable, or if appropriate therapy and orthotic care are not available. Muscle imbalance produces the problem of deformity and instability of the hip. Deformity must be corrected if the child is to assume an upright posture. Instability is of concern only in those children with a strong quadriceps muscle. Hip surgery for instability should be limited to one procedure, which must achieve a stable concentric reduction and balance the muscle forces about the hip. The common deformities seen at the knee are recurvatum, knee flexion contractures, and genu valgum. Most knee deformities can be corrected by soft tissue procedures. Well-designed orthoses rocker sole shoes, and appropriate gait training help prevent knee deformities. The goal in managing foot deformities is to achieve a plantigrade foot with stable skin. Whenever there is a problem with sensation, concentrated pressure in one area of a deformed foot will lead to skin breakdown. Surgical procedures must completely correct deformity and restore muscle imbalance. After surgery, meticulous orthotic care is required to prevent skin breakdown and avoid loss of correction. The orthopedist has a significant role in helping a child with spina bifida to achieve a pattern of development as near normal as possible. He or she must work in concert with a team of professionals and realize that orthopedic surgery is but an incident in the habilitative program. This rather chatty narrative is based on spina bifida care experience, in Sheffield, Toronto, and Chicago.