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Foot deformities secondary to gluteal injection in infancy
Insights
Gluteal intramuscular injections in children can cause sciatic nerve dysfunction leading to foot deformities like cavovarus. The superolateral gluteal region is recommended as the preferred injection site to prevent such injuries.
Area of Science:
- Pediatric Orthopedics
- Pediatric Neurology
- Clinical Research
Background:
- Intramuscular injections are common in pediatric care.
- Sciatic nerve injury can result from improper injection techniques.
- Foot deformities are a potential complication of nerve damage.
Observation:
- Six pediatric cases of foot deformities secondary to sciatic nerve dysfunction were observed.
- The dysfunction appeared to be caused by gluteal intramuscular injections.
- Deformities included cavovarus and calcaneocavus foot, with some cases also showing ankle equinus.
Findings:
- Five patients developed significant foot deformities requiring intervention.
- One patient experienced complete foot palsy resolution without developing deformities.
- Successful correction of deformities and muscle imbalances led to plantigrade gait in affected patients.
Implications:
- Proper site selection for gluteal intramuscular injections is crucial in children.
- The superolateral gluteal area is identified as the preferred injection site.
- Early identification and surgical correction of nerve-induced foot deformities are essential for functional recovery.
Abstract:
We report six cases of foot deformities in children due to sciatic nerve dysfunction that appear to have been caused by gluteal intramuscular injection. Of four patients who developed cavovarus foot deformities, two also exhibited a component of ankle equinus. A fifth patient had a calcaneocavus foot deformity. In the sixth patient foot palsy resolved completely 1 year after injury, and no deformities developed. Identification of the muscle imbalance, as well as appropriate correction of the deformity before the implementation of muscle balancing procedures, led to the attainment of a satisfactory plantigrade gait in the first five patients with deformities. Bases on our experience with these six cases and reports in the literature, we recommend that the superolateral gluteal area between the crest of the ilium and the greater trochanter be properly defined as the preferred site for intramuscular injection.