OBJECTIVE: Selective neurotomy is generally a safe, effective, and long-lasting treatment for patients with spastic equinovarus foot deformity. We retrospectively analyzed the results of microsurgical selective tibial neurotomy (STN) for spastic feet in adults and children. METHODS: A neurosurgeon selected 32 patients with 45 spastic feet (adults : 13, children : 32) to undergo microsurgical STN between October 1998 and September 2007. A physician of rehabilitation assessed spasticity pre- and postoperatively, that was based on the Ashworth scale, ankle clonus, and the amplitude of ankle dorsiflexion. The mean postoperative follow-up period was 36.7 months in adults and 42.5 months in children. RESULTS: Spastic components of the feet were corrected immediately after surgery in both the adult and child groups. The mean Ashworth's grade changed from 3.6 +/- 0.40 to 1.6 +/- 0.70 in adults and from 3.7 +/- 0.69 to 1.4 +/- 0.49 in children. Mean ankle clonus decreased markedly, from 1.6 +/- 0.79 to 0.3 +/- 0.42 in adults and from 1.7 +/- 0.65 to 0.3 +/- 0.56 in children. The mean amplitude of ankle dorsiflexion was improved, but eight (adults: 4, children: 4) contracted feet needed complementary orthopedic correction for acceptable results. CONCLUSION: STN can be effective in the long-term for improving lower limb function and reduction of equinovarus deformity. Our results demonstrate that STN might be an effective procedure for treating localized harmful spastic feet in adults and children.
Adult ; Animals ; Ankle ; Child ; Clubfoot ; Congenital Abnormalities ; Contracts ; Follow-Up Studies ; Foot ; Foot Deformities ; Humans ; Lower Extremity ; Muscle Spasticity ; Orthopedics ; Retrospective Studies

Three cases of Volkmann's ischemic contracture in the lower extremity, which is relatively rare manifestation, are reported, One case has occurred as a complication of snake-bite, another was followed by CO intoxication and the third was caused by a direct trauma, which gave a rupture of the main artery in the thigh. The common clinical manifestation were deformity of the foot as equinus, equinovarus and cavus deformities. One case had an additional flexion contracture of the knee. One case was opearted by Achilles tendon lengthening, posterior capsulotomy of the ankle, and plantar fasciotomy, another case was operated by supracondylar osteotomy of the femur in order to correct flexion deformity of the knee followed by B-K amputation, the third was operated by triple arthrodesis of the foot with dorsal wedging.
Achilles Tendon ; Amputation ; Ankle ; Arteries ; Arthrodesis ; Clubfoot ; Congenital Abnormalities ; Contracture ; Femur ; Foot ; Foot Deformities ; Ischemic Contracture ; Knee ; Lower Extremity ; Osteotomy ; Posterior Capsulotomy ; Rupture ; Thigh

PURPOSE: To clarify the relationship between the level of neurologic deficit and deformity of the lower extremity and also the ambulatory status. MATERIALS AND METHODS: We performed retrograde analysis on 79 patients older than 30months with lipomeningocele. All of the patients were classified according to the level of neurologic functional motor deficit. There were 52 males and 27 females patients. Average age was 6 years and 8 months. RESULTS: There was only one patient in the upper lumbar (L1-L2) motor level deficit. He was a non ambulator. Among the 26 with lower lumbar (L3-L5) deficit, 6 were household ambulators, 20 were community ambulators; 2 had hip deformities and 22 had foot deformities. Among the 48 patients with sacral (S1-S3) deficit, all were community ambulators; 3 had hip deformities and 27 had foot deformities. In 4 patients who showed normal motor function, all were community ambulators without any deformity. CONCLUSION: In lipomeningocele, patients who had a functional motor deficit above L4 level showed poor ambulatory status. However, those below L4 level showed good ambulation, and in cases with the L4-5 motor level deficit, we were able to improve the ambulatory status after correction of the deformities of the lower extremity.
Congenital Abnormalities* ; Family Characteristics ; Female ; Foot Deformities ; Hip ; Humans ; Lower Extremity ; Male ; Neurologic Manifestations* ; Walking

Most rotational and angulational variations in young children are benign and resolved spontaneously. However, they may cause great concerns to parents. In order to provide a deliberate assessment and management of lower limb rotational and angulational problems, it is necessary for pediatricians to understand the normal variations of lower limb development in healthy children combined with the features of child growth and development and detail physical examinations.
Humans ; Lower Extremity ; embryology ; Lower Extremity Deformities, Congenital ; diagnosis ; therapy ; Rotation

Macrodystrophia lipomatosa (MDL) is a rare congenital non-hereditary disorder that has significant impact on patient morbidity. This study provides a comprehensive review of the natural history, diagnosis, management, and outcomes of the disorder. A literature search in PubMed was conducted to identify cases of MDL from January 1950 to 14 February 2014. After ruling out articles without information related to the management of the disorder, a summary of 32 studies was performed. An additional three cases from the authors are also presented. Based on 57 journal articles and three additional cases from the authors, around 108 cases of MDL were reviewed. Most patients were males who were admitted to a treatment clinic in the first four years of life. The lower extremities were more frequently affected, with unilateral presentation being most common. They commonly underwent a single-staged surgical procedure with follow-up periods ranging from more than one year up to 21 years. Out of 43 cases that underwent surgical procedures, 13 reported no complications, and there were seven cases of esthetic satisfaction and 15 cases of significant functional improvement. Depending on the severity of a patient's condition, the use of non-invasive diagnostic tools should be carefully considered. Surgery might be a better choice of management than observation, taking into account possible future complications in the absence of surgery and the beneficial outcomes of surgical procedures.
Diagnosis ; Fingers ; Follow-Up Studies ; Humans ; Limb Deformities, Congenital ; Lower Extremity ; Male ; Natural History ; Upper Extremity

Child ; Female ; Humans ; Ilizarov Technique ; Lower Extremity Deformities, Congenital ; surgery ; Tibia ; abnormalities ; surgery

PURPOSE: Past classification for the treatment of idiopathic genu vara depended simply on the measurement of distance between the knees, without attention to the rotational profile of the lower extremity. We retrospectively analyzed anatomical causes of idiopathic genu vara. PATIENTS AND METHODS: Twenty eight patients with idiopathic genu vara were included in this study. All patients were surgically treated. To evaluate the angular deformity, a standing orthoroentgenogram was taken and the lateral distal femoral angle and the medial proximal tibial angle were measured. In order to assess any accompanying torsional deformity, both femoral anteversion and tibial external rotation were measured using computerized tomographic scans. A derotational osteotomy was performed at the femur or tibia to correct rotational deformity, and a correctional osteotomy was performed at the tibia to correct angular deformity. RESULTS: Satisfactory functional results were obtained in all cases. Genu vara was divided into 3 groups according to the nature of the deformity; group 1 (6 patients) with increased femoral anteversion, group 2 (10 patients) with proximal tibial varus deformity alone, and group 3 (12 patients) with proximal tibial varus deformity accompanied by increased external tibial rotation. CONCLUSION: The success seen in our cases highlights the importance of an accurate preoperative analysis that accounts for both rotational and angular deformities that may underlie idiopathic genu vara.
Adolescent ; Adult ; Child ; Female ; Humans ; Leg/*abnormalities/pathology/surgery ; Lower Extremity Deformities, Congenital/classification/pathology/surgery ; Male ; Retrospective Studies

Holt-Oram syndrome (HOS) is the most common heart-hand syndrome, which is inherited in an autosomal dominant manner, but most cases are sporadic. This condition is characterized by upper-extremity malformations involving radial-ray, thenar, and carpal bones, and congenital heart malformations including atrial septal defect and ventricular septal defect. It is caused by mutations in the TBX5 gene. In this report, a Korean case with HOS is described, which is inherited from her father. A novel nonsense mutation, p.Glu294*, was identified. This is the first Korean case with HOS confirmed by genetic testing.
Abnormalities, Multiple ; Carpal Bones ; Codon, Nonsense ; Fathers ; Genetic Testing ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Lower Extremity Deformities, Congenital ; Upper Extremity Deformities, Congenital

Holt-Oram syndrome (HOS) is the most common heart-hand syndrome, which is inherited in an autosomal dominant manner, but most cases are sporadic. This condition is characterized by upper-extremity malformations involving radial-ray, thenar, and carpal bones, and congenital heart malformations including atrial septal defect and ventricular septal defect. It is caused by mutations in the TBX5 gene. In this report, a Korean case with HOS is described, which is inherited from her father. A novel nonsense mutation, p.Glu294*, was identified. This is the first Korean case with HOS confirmed by genetic testing.
Abnormalities, Multiple ; Carpal Bones ; Codon, Nonsense ; Fathers ; Genetic Testing ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Lower Extremity Deformities, Congenital ; Upper Extremity Deformities, Congenital

PURPOSE: Dyna-ATC is a unilateral external fixator with angulator, lengthener, and translator, which allows for angular correction and compensation of the secondary displacement during angular correction. The purpose of this study is to introduce surgical technique and calculation methods and to evaluate the clinical outcome of angular deformity correction using Dyna-ATC. MATERIALS AND METHODS: The amounts of secondary displacement were calculated with the distances between axis of correction of angulation, Center of Rotational Angulation, and osteotomy and the amount of angular deformity. The rate of angular correction was determined to distract the corticotomy at 1 mm/day. Clinical and radiographic evaluation was performed on 13 patients who underwent deformity correction using Dyna-ATC. There were 8 proximal tibia vara, 1 tibia valga, 2 varus and 4 valgus deformities on distal femur. One patient underwent pelvic support femoral reconstruction. Concomitant lengthening was combined in all femur cases. Mean age at surgery was 17.5 years (7 to 64). RESULTS: All but one achieved bony healing and normal alignment with the index procedure. Mean mechanical axis deviation improved from 31.9 mm to 3.0 mm. The average amount of angular correction was 11.0degrees on tibiae and 10.0degrees on femora. The average length gain on femora was 6.4 cm, and the healing index averaged to 1.1 mo/cm. One patient underwent quadricepsplasty and one patient had three augmentation surgeries due to poor new bone formation. CONCLUSION: We believe that Dyna-ATC is a useful alternative to bulky ring fixators for selective patients with angular deformity less than 30 degrees in the coronal plane around the knee joint.
Adolescent ; Bone Diseases, Developmental/*surgery ; Child ; *External Fixators ; Female ; Femur/abnormalities/surgery ; Humans ; Leg Length Inequality/surgery ; Lower Extremity Deformities, Congenital/*surgery ; Male ; Middle Aged ; Osteochondrosis/congenital/surgery ; Osteogenesis, Distraction/*instrumentation/methods/statistics & numerical data ; Osteotomy ; Tibia/abnormalities/surgery ; Treatment Outcome ; Young Adult