[Long-term effects of foot orthoseson leg muscles activity in individuals with pesplanus during walking]

Foot orthoses are widely prescribed to treat a range of lower extremity problems. Long-term biomechanical effects of foot orthosesare not clearly documented in the literature. The aim of this study was to examine long-term effects of foot orthoses on leg muscles activity in individuals with pesplanus during walking. In this clinical trial we selected 45 subjects after clinical examination. The subjects were divided into three equal groups: experimental pesplanus, control pesplanus and a healthy control group [with normal feet]. In the pre-test stage, electrical activity of leg muscles including tibialis anterior, peroneus longus, medial gastrocnemius and soleus were recorded at stance phase of walking, while all subjects walked barefoot along a 14m line. Experimental pesplanus group wore the custom-made orthoses for a period of six months. Then experimental pesplanus and control pesplanus groups underwent post-test. One-way ANOVA was used for data analysis. After six months of utilizing foot orthoses, the tibialis anterior activity significantly decreased in contact sub-phase [P=0.006]. The medial gastrocnemius activity showed a significant decrease in midstance sub-phase in the post-test [P=0.007]. Also, the soleus muscle had decreased activity in contact [P=0.033] and midstance [p=0.023] sub-phases in the post-test. According to the results of this study, we found that long term use of foot orthoses could change muscle activation and result in secondary adaptation

Tríplice artrodese na paralisia cerebral / Triple arthrodesis in cerebral palsy

OBJETIVOS: Avaliar o resultados clínicos díplice artrodese em portadores de paralisia cerebral espástica, verificar a correspondência entre os resultados e a escala AOFAS e os ângulos nos períodos pré e pós-operatórios. MÉTODOS: Entre 1985 e 2005, foram avaliados 34 pacientes (40 pés) submetidos a tríplice artrodese do pé, com acompanhamento médio de 91 meses, quanto a satisfação e dor, apoio plantígrado, deformidade residual e o arco de movimento do tornozelo e escala AOFAS. Foram avaliadas artrose de tornozelo, pseudoartrose das articulações e medidos os ângulos: talocalcâneo, talo-primeiro metatarsiano (APM) e tíbio-talar, e talocalcâneos (ATC) e o calcâneo-solo (ACS). RESULTADOS: Obtivemos bons resultados em 32,4 por cento dos casos e regulares em 44,1 por cento. 85,3 por cento dos pacientes estavam satisfeitos; 88,2 por cento tinham apoio plantígrado. Houve 33,3 por cento de resultados bons pela escala AOFAS e 24,2 por cento regulares. Na radiografia com incidência ântero-posterior, o APM apresentou melhora em média de 15º; no ACS, na incidência em perfil, melhora de 7º. No ATC, nas duas incidências, houve melhora de 1º. CONCLUSÕES: A triplice artrodese corrige ou melhora as deformidades, com grau de satisfação elevada, dando ao paciente pés plantígrados. A escala AOFAS teve fraca concordância com o resultado. Os APM e ACS foram os mais sensíveis na avaliação do procedimento cirúrgico.

OBJECTIVE: To demonstrate the clinical results of triple arthrodesis in Cerebral Palsy patients and determine whether there is any correspondence between the results and the AOFAS scale, and changes in radiographic angles between the pre- and postoperative periods. METHODS: Between 1985 and 2005, thirty-four patients (40 feet) were submitted to triple arthrodesis of the foot, with an average follow-up time of ninety-one months. The evaluation consisted of the patient's satisfaction and the presence of pain, plantigrade support, residual deformity, range of movement of the ankle, and the AOFAS. Radiographs were made of the foot and ankle to assess the presence of ankle arthrosis, pseudarthrosis of the joints, and measurements of the following angles: talocalcaneal, talur-first metatarsal and tibiotalar, and talocalcaneal and calcaneal pitch. RESULTS: The results were good in 32.4 percent of cases, regular in 44.1 percent, satisfactory in 85.3 percent and 88.2 percent had plantigrade support. With the AOFAS scale, the results were good in 33.3 percent and regular in 24.2 percent. In the radiogra-phic assessment, the AP talar-first metatarsal angle showed an average improvement of 15º, the LAT calcaneous pitch improved by 7º. The talocalcaneal angles, both AP and LAT, improved in 1º. CONCLUSIONS: This study concluded that the triple arthrodesis corrects or improves these deformities; the patient showed a high level of satisfaction, most of them with a plantigrade foot. The AOFAS scale had low correlation with the result. The talur-first metatarsal and calcaneal pitch were the most sensitive in the evaluation of the surgical procedure.

Spinal muscular atrophy type II (intermediary) and III (Kugelberg-Welander): evolution of 50 patients with physiotherapy and hydrotherapy in a swimming pool

We added hydrotherapy to 50 patients with spinal muscular atrophy (SMA) who were being treated with individual convencional physiotherapy. Hydrotherapy was performed at an approximate temperature of 30 degrees Celsius, twice a week, for thirty minutes in children and for forty-five minutes in adults during a 2-year period. The outcome derived from this combined modality of treatment was rated according to physiotherapeutic evaluations, the MMT (Manual Muscular Test), and the Barthel Ladder. Patients were reevaluated at 2-month intervals. After two years of ongoing treatment, we were able to observe that the deformities in hip, knee and foot were progressive in all SMA Type II patients, and in some Type III. Muscle strength stabilized in most SMA Type III patients, and improved in some, MMT was not done in SMA Type II. In all patients we were able to detect an improvement in the Barthel Ladder scale. This study suggests that a measurable improvement in the quality of daily living may be obtained in patients with SMA Types II and III subjected to conventional physiotherapy when associated with hydrotherapy.

Uso de los fijadores externos en el tratamiento definitivo de las metatarsalgias por discrepancia de longitud: comunicación preliminar / The use of external fixators for definitive treatment of metatarsalgia produced by metatarsal shortening. Preliminary report

Se revisaron 10 casos de metatarsalgias que en su mayoría fueron pacientes adolescentes, quienes, por causa congénita o adquirida, presentaron acortamiento de los metatarsianos. Fueron tratados mediante alargamiento óseo con fijadores externos diseñados y fabricados en el Instituto Nacional de Ortopedia. En el 90 por ciento de los pacientes tratados con este método se obtuvieron buenos resultados, tanto clínica como radiográficamente. Recobraron la distribución normal de la carga que se ejerce sobre la planta del pie. La deformidad en garra del dedo correspondiente al metatarsiano afectado también se corrigió. Igualmente, se observó desaparición del surco plantar de la insuficiencia que siempre acompaña a esta deformidad. No se observaron complicaciónes importantes que a juicio del autor contraindiquen la metodología