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Muscle imbalance in the aetiology of idiopathic club foot. An electromyographic study
Z Feldbrin1, A N Gilai, E Ezra
1Department of Pediatric Neurology, Dana Children's Hospital, Tel-Aviv Medical Centre, Israel.
Insights
Electrophysiological studies reveal nerve and spinal cord abnormalities in most children with idiopathic clubfoot, often linked to deformity severity. Normal findings indicate a good prognosis, suggesting muscle imbalance as a key cause.
Area of Science:
- Neurology
- Orthopedics
- Pediatrics
Background:
- Idiopathic clubfoot is a common congenital foot deformity.
- Its exact etiology, particularly the role of neurogenic factors, remains debated.
- Understanding neurophysiological involvement is crucial for prognosis and treatment.
Purpose of the Study:
- To investigate neurophysiological abnormalities in children with idiopathic clubfoot using electrophysiological studies.
- To correlate electrophysiological findings with clinical severity and treatment outcomes.
- To explore the potential role of muscle imbalance as an etiological factor.
Main Methods:
- Electrophysiological studies were conducted on the lower limbs of 52 children (3 months to 15 years) diagnosed with idiopathic clubfoot.
- Nerve conduction studies and electromyography were utilized to assess peripheral nerve and spinal cord function.
- Follow-up studies were performed in a subset of patients to evaluate changes over time.
Main Results:
- Abnormal electrophysiological findings were present in 83% of the children studied.
- Isolated peroneal nerve damage occurred in 27%, combined peroneal and posterior tibial nerve abnormalities in 10%, and spinal cord dysfunction in 8%.
- Combined spinal cord and peripheral nerve lesions were observed in 27% of patients. Pathological findings were more frequent in conservatively treated patients (66%) and those with poor surgical outcomes (100% of 16 cases).
- No significant progression or improvement was noted in repeated studies.
- The multiplicity of pathological findings correlated with the severity of the foot deformity.
Conclusions:
- Electrophysiological studies are valuable in evaluating idiopathic clubfoot, especially in cases with residual deformities post-treatment.
- Normal electrophysiological studies are a positive prognostic indicator.
- The findings support the hypothesis that muscle imbalance is a significant etiological factor in idiopathic clubfoot.
Abstract:
We performed electrophysiological studies on both legs of 52 children, aged from 3 months to 15 years, with idiopathic club foot. In only nine (17%) was no abnormality found. Isolated peroneal nerve damage was seen in 14 (27%). Abnormality of both peroneal and posterior tibial nerves was found in five (10%). Four patients (8%) had evidence of isolated spinal-cord dysfunction, whereas combined spinal-cord and peripheral-nerve lesions were seen in 14 (27%). Six patients (11%) had variable neurogenic electrophysiological patterns. In 13 patients in whom the studies were repeated neither progression nor improvement of the electrophysiological parameters was observed. Pathological electrophysiological findings were found in 66% of conservatively-treated patients. In the 43 patients treated surgically, all 16 with fair and poor results had pathological electrophysiological findings and 12 required further operations. Multiplicity of the pathological findings was related to the severity of the deformity of the foot; normal studies represent a good prognostic sign. Electrophysiological studies are useful in idiopathic club foot with residual deformities after conservative or operative treatment. Our findings support the theory that muscle imbalance is an aetiological factor in idiopathic club foot.