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Journal of Neurorestoratology  2019, Vol. 7 Issue (3): 153-160    doi: 10.26599/JNR.2019.9040016
Research Article     
The treatment of neurotrophic foot and ankle deformity of spinal bifida: 248 cases in single center
Jiancheng Zang1,2,3,Sihe Qin1,2,3,(✉)(),Vigneshwaran P4(),Lei Shi1,2,3(),Xulei Qin1,2,3()
1 Orthopeadics Department of Chinese National Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids (NRRA), Beijing 100176, China
2 Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Beijing, 100176, China
3 Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing 100176, China
4 Sri Hospitals, Chennai 600081, India
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Abstract  Objective:

To evaluate the functional outcome of foot and ankle deformity secondary to spinal bifida treated by various methods.

Methods:

A retrospective analysis of 248 patients with foot and ankle deformity secondary to spina bifida with an average age of 25.5 years and underwent surgical treatment in our hospital from March 2012 to April 2016. The deformity correction was achieved by various methods like soft tissue procedure, bony procedure combined with external fixator application. All the patients were followed up at regular interval. Post operative rehabilitation and protective splints were provided after fixator removal. The final outcome was evaluated with American Orthopedic Foot and Ankle Society (AOFAS) score and Qin’s criteria for deformity correction, matched T-test was used to compare the data pre and post surgery.

Results:

According to the short term follow up, all these patients were achieved complete correction and able to achieve full weight bearing. Out of 248 patients, 13 patients were lost follow up. 235 patients were followed up for an average of 28.5 months. We noted various minor complications like superficial pin tract infection was seen in 5, pin breakage in 4, pin tract burn injury in 1, and recurrence of deformity was noted in 20 patients especially in children, anterior dislocation of the tibiotalar joint in 3 patients with severe clubfoot deformity. At the final follow up, the mean AOFAS score increased to 88.7, with a significant improvement compared with the score before surgery (P < 0.05). Based on Qin’s criteria for deformity correction, the outcome was graded as excellent in 180 patients, good in 55, and fair in none of the cases.

Conclusion:

Through orthopaedic treatment, combination of soft tissue and bony procedures along with external fixator helps to achieve complete correction of deformity, healing of ulcer, restoration of functional activity for spinal bifida sequelae patients.



Key wordsneurotrophic foot      ulcer      foot and ankle      spinal bifida      orthopedic treatment     
Received: 09 August 2019      Published: 18 September 2019
Corresponding Authors: Sihe Qin     E-mail: qinsihe@163.com;vikki_00781@yahoo.com;mailshilei@163.com;975158088@qq.com
About author: Jiancheng Zang, affiliates to Orthopeadics Department of Chinese National Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs. He focuses on limb deformity correction and functional reconstruction, including congenital and acquired limb disabilities secondary to spina bifida, poliomyelitis, cerebral palsy, and traumatic sequelae, etc. E-mail: Jianch88@aliyun.com.|Sihe Qin, affiliates to Orthopeadics Department of Chinese National Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs. He has engaged in orthopedics (limb deformity correction and functional reconstruction) more than 40 years, and has conducted surgery in 35075 cases. E-mail: qinsihe@163.com.|Vigneshwaran P, affiliates to Orthopeadics Department of Sri Hospitals. He is a consultant of orthopedic trauma and Ilizarov surgeon. He focuses on deformity correction and limb lengthening. E-mail: vikki_00781@yahoo.com.|Lei Shi, affiliates to Orthopeadics Department of Chinese National Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids. He focuses on limb deformity correction and functional reconstruction. E-mail: mailshilei@163.com.|Xulei Qin, affiliates to Orthopeadics Department of Chinese National Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids. He focuses on limb deformity correction and functional reconstruction. E-mail: 975158088@qq.com.
Cite this article:

Jiancheng Zang,Sihe Qin,Vigneshwaran P,Lei Shi,Xulei Qin. The treatment of neurotrophic foot and ankle deformity of spinal bifida: 248 cases in single center. Journal of Neurorestoratology, 2019, 7: 153-160.

URL:

http://jnr.tsinghuajournals.com/10.26599/JNR.2019.9040016     OR     http://jnr.tsinghuajournals.com/Y2019/V7/I3/153

Table 1 Qin’s postoperative evaluation criteria for lower limb reconstruction.
Preoperative score (n)Postoperative score (n)P value
Clubfoot67.05 ± 5.5 (134)86.16 ± 3.62 (134)0.046
Valgus foot70.45 ± 10.3 (30)85.45 ± 6.55 (30)0.039
Calcaneal foot68.46 ± 7.3 (37)83.41 ± 5.42 (37)0.035
Cavus foot72.26 ± 4.7 (34)84.92 ± 5.18 (34)0.045
Table 2 The pre and post operative AOFAS scores.
CategoryExcellentGoodFairPoor
Clubfoot973700
Valgus foot26400
Calcaneal foot32500
Cavus foot25900
Total1805500
Table 3 The outcome based on Qin’s criteria for deformity correction.
Fig. 1 A typical case: female, 18 years old, bilateral equinovarus foot deformities of spinal bifida sequela. (A) Equinovarus foot deformity bilateral sides. (B) X-ray showed vertebral defect in lumbosacral region. (C) The operation included posterior tibia muscle lengthening, the triple joint osteotomy and fixation with an Ilizarov fixator gradually correcting the deformity to neutral position. AFO was applied when fixator removal. (D) 2 years follow-up, her foot and ankle deformities were corrected completely.
[1]   Chong C, Molet J, Oliver B, et al. The tethered cord syndrome: a review of causes. Neurologia. 1994, 9(1): 12-18.
pmid: 8161462
[2]   Gunay H, Sozbilen MC, Gurbuz Y, et al. Incidence and type of foot deformities in patients with spina bifida according to level of lesion. Childs Nerv Syst. 2016, 32(2): 315-319.
doi: 10.1007/s00381-015-2944-7 pmid: 26518781
[3]   Westcott MA, Dynes MC, Remer EM, et al. Congenital and acquired orthopedic abnormalities in patients with myelomeningocele. Radiographics. 1992, 12(6): 1155-1173.
doi: 10.1148/radiographics.12.6.1439018 pmid: 1439018
[4]   Noonan KJ, Didelot WP, Lindseth RE. Care of the pediatric foot in myelodysplasia. Foot Ankle Clin. 2000, 5(2): 281–304, vi.
pmid: 11232237
[5]   Swaroop VT, Dias L. Orthopaedic management of spina bifida-part II: foot and ankle deformities. J Child Orthop. 2011, 5(6): 403-414.
doi: 10.1007/s11832-011-0368-9
[6]   Kameshita K. Therapy of foot deformities in spina bifida. Nippon Seikeigeka Gakkai Zasshi. 1987, 61(10): 1159-1173.
pmid: 3325586
[7]   Tita AC, Frampton JR, Roehmer C, et al. Correlation between neurologic impairment grade and ambulation status in the adult spina bifida population. Am J Phys Med Rehabil. 2019, in press, DOI 10.1097/PHM.0000000000001188.
doi: 10.1097/PHM.0000000000001378 pmid: 31876543
[8]   Bradko V, Castillo H, Janardhan S, et al. Towards guideline-based management of tethered cord syndrome in spina bifida: A global health paradigm shift in the era of prenatal surgery. Neurospine. 2019, in press, DOI 10.14245/ns.1836342.171.
doi: 10.14245/ns.1836198.099 pmid: 31805760
[9]   Chen L, Nie H, Huang H, et al. Three cases of tethered release combined with olfactory ensheathing cell transplantation (in Chinese). Chin J Clinicians (Electronic Edition). 2010, 4(11):2311-2312.
[10]   Wang ZH, Gao JQ, Zhan XH, et al. One-stage debridement and two-stage Ilizarov bone transport technology for post-traumatic lateral malleolus defect (in Chinese). Chin J Reparative Reconstr Surg. 2019, 33(7): 865-870.
doi: 10.7507/1002-1892.201901091 pmid: 31298005
[11]   Zang JC, Qin SH, Qin XL, et al. Treatment strategy for flail foot with sensory disorder of spina bifida sequela in adult (in Chinese). Chin J Repar Reconstr Surg. 2018, 32(10): 1255-1260.
doi: 10.7507/1002-1892.201808076 pmid: 30600664
[12]   Cotter AM, Daly SF. Neural tube defects: is a decreasing prevalence associated with a decrease in severity? Eur J Obstet Gynecol Reprod Biol. 2005, 119(2): 161-163.
doi: 10.1016/j.ejogrb.2004.06.028
[13]   Dicianno BE, Beierwaltes P, Dosa N, et al. Scientific methodology of the development of the guidelines for the care of people with spina bifida: an initiative of the spina bifida association. Disabil Health J. 2019: S1936–S6574(19)30106–2.
doi: 10.1016/j.dhjo.2019.100881 pmid: 31875836
[14]   Carroll NC. Assessment and management of the lower extremity in myelodysplasia. Orthop Clin North Am. 1987, 18(4): 709-724.
pmid: 3313170
[15]   Shanahan MD, Douglas DL, Sharrard WJ, et al. The long-term results of the surgical management of paralytic pes cavus by soft tissue release and tendon transfer. Surg Infancy Child. 1985, 40(): 37-41.
doi: 10.1055/s-2008-1059765 pmid: 3911642
[16]   Nicol RO, Menelaus MB. Correction of combined tibial torsion and Valgus deformity of the foot. J Bone Joint Surg Br. 1983, 65(5): 641-645.
pmid: 6358232
[17]   Zhang Z, Zang JC, Qin S. Effectiveness of Ilizarov technique in treatment of clubfoot after burns (in Chinese). Chin J Repar Reconstr Surg. 2018, 32(2): 178-181.
doi: 10.7507/1002-1892.201709052 pmid: 29806408
[18]   Lee DY, Choi IH, Yoo WJ, et al. Application of the Ilizarov technique to the correction of neurologic equinocavovarus foot deformity. Clin Orthop Relat Res. 2011, 469(3): 860-867.
doi: 10.1007/s11999-010-1497-z pmid: 20694536
[19]   Panda PK, Mallik KC, Patel R, et al. Molecular basis of spina bifida: recent advances and future prospectives. J Pediatr Neurosci. 2019, 14(1): 16-19.
doi: 10.4103/jpn.JPN_20_19 pmid: 31316638
[20]   Huang HY, Mao GS, Feng SQ, et al. 2016 yearbook of Neurorestoratology. J Neurorestoratology. 2017, 5: 111-115.
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