Ankle and Foot Spasticity Patterns in Chronic Stroke Survivors with Abnormal Gait
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Gastrocnemius and Soleus Muscle Stretching Exercises
KEVIN A. KIRBY, D.P.M. www.KirbyPodiatry.com www.facebook.com/kevinakirbydpm Sports Medicine, Foot Surgery, Pediatric & Adult Foot Disorders 107 Scripps Drive, Suite #200, Sacramento, CA 95825 (916) 925-8111 Gastrocnemius and Soleus Muscle Stretching Exercises Gastrocnemius Stretch Soleus Stretch Figure 1. In the illustration above, the gastrocnemius muscle of the left leg is being Figure 2. In the illustration above, the soleus stretched. To effectively stretch the gastroc- muscle of the left leg is being stretched. To nemius muscle the following technique must be effectively stretch the soleus muscle the following followed. First, lean into a solid surface such as a technique must be followed. While keeping the wall and place the leg to be stretched behind the back foot pointed straight ahead toward the wall other leg. Second, make sure that the foot behind and keeping the heel on the ground, the knee of you is pointing straight ahead toward the wall. the back leg must be flexed. During the soleus Third, tighten up the quadriceps (i.e. thigh stretch, it helps to try to move your hips further muscles) of the leg that is being stretched so that away from the wall and to drive your back knee the knee will be as straight as possible. Now toward the ground, while still keeping your heel on gradually lean into the wall by slowly bending your the ground. Just before the heel lifts from the elbows, with the heel of the foot always touching ground, stop and hold the stretch for 10 seconds, the ground. Just before the heel lifts from the trying to allow the muscles of the lower calf to relax ground, stop and hold the stretch for 10 seconds, during the stretch. -
Tibialis Posterior Tendon Transfer Corrects the Foot Drop Component
456 COPYRIGHT Ó 2014 BY THE JOURNAL OF BONE AND JOINT SURGERY,INCORPORATED Tibialis Posterior Tendon Transfer Corrects the Foot DropComponentofCavovarusFootDeformity in Charcot-Marie-Tooth Disease T. Dreher, MD, S.I. Wolf, PhD, D. Heitzmann, MSc, C. Fremd, M.C. Klotz, MD, and W. Wenz, MD Investigation performed at the Division for Paediatric Orthopaedics and Foot Surgery, Department for Orthopaedic and Trauma Surgery, Heidelberg University Clinics, Heidelberg, Germany Background: The foot drop component of cavovarus foot deformity in patients with Charcot-Marie-Tooth disease is commonly treated by tendon transfer to provide substitute foot dorsiflexion or by tenodesis to prevent the foot from dropping. Our goals were to use three-dimensional foot analysis to evaluate the outcome of tibialis posterior tendon transfer to the dorsum of the foot and to investigate whether the transfer works as an active substitution or as a tenodesis. Methods: We prospectively studied fourteen patients with Charcot-Marie-Tooth disease and cavovarus foot deformity in whom twenty-three feet were treated with tibialis posterior tendon transfer to correct the foot drop component as part of a foot deformity correction procedure. Five patients underwent unilateral treatment and nine underwent bilateral treatment; only one foot was analyzed in each of the latter patients. Standardized clinical examinations and three-dimensional gait analysis with a special foot model (Heidelberg Foot Measurement Method) were performed before and at a mean of 28.8 months after surgery. Results: The three-dimensional gait analysis revealed significant increases in tibiotalar and foot-tibia dorsiflexion during the swing phase after surgery. These increases were accompanied by a significant reduction in maximum plantar flexion at the stance-swing transition but without a reduction in active range of motion. -
“Swollen Ankle” Due to the Presence Of
f Bone R o e al s n e r a u r c o h J Journal of Bone Research Bojinca et al., J Bone Res 2017, 5:2 ISSN: 2572-4916 DOI: 10.4172/2572-4916.1000177 Case Report Open Access “Swollen Ankle” Due to the Presence of Accessory Soleus Muscle - Case Report Violeta Claudia Bojinca¹*, Teodora Andreea Serban² and Mihai Bojinca² ¹Department of Internal Medicine and Rheumatology, Hospital “Sfanta Maria”, University of Medicine and Pharmacy “Carol Davila”, Romania ²Department of Internal Medicine and Rheumatology, Hospital “Dr. Ion Cantacuzino”, University of Medicine and Pharmacy “Carol Davila”, Romania *Corresponding author: Violeta Claudia Bojinca, Department of Internal Medicine and Rheumatology, Hospital “Sfanta Maria”, Ion Mihalache Blv. 37-39, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania, Tel: +40723924823; Fax +40212224064; E-mail: [email protected] Received Date: June 26, 2017; Accepted Date: July 10, 2017; Published Date: July 17, 2017 Copyright: © 2017 Bojinca CV, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Swollen ankle might be a problem of differential diagnosis in young patients performing physical exercises. A mass on the posteromedial region of the ankle might be attributed to the presence of Accessory Soleus Muscle (ASM), the most common supernumerary muscle in the lower leg. We present the case of a young male with swelling and moderate pain on the posteromedial part of the right ankle after prolonged physical exercise. -
Chronic Tibialis Anterior Tendon Tear Treated with an Achilles Tendon Allograft Technique
n tips & techniques Section Editor: Steven F. Harwin, MD Chronic Tibialis Anterior Tendon Tear Treated With an Achilles Tendon Allograft Technique Ezequiel Palmanovich, MD; Yaron S. Brin, MD; Lior Laver, MD; Dror Ben David, MD; Sabri Massrawe, MD; Meir Nyska, MD; Iftach Hetsroni, MD tus,16,17 rheumatoid arthritis,17 erative tibialis anterior tendon Abstract: Tibialis anterior tendon tear is an uncommon in- psoriasis,18 and deposition of was diagnosed clinically and jury. Nontraumatic or degenerative tears are usually seen gout tophi19,20 also have been confirmed by ultrasound. in the avascular zone of the tendon. Treatment can be con- reported to be associated with After 3 months of phys- servative or surgical. Conservative treatment is adequate tendon ruptures. In older pa- iotherapy treatment without for low-demand older patients. For active patients, surgical tients and in partial tears, non- improvement, surgical treat- treatment can be challenging for the surgeon because after operative treatment has been ment was recommended. The debridement of degenerative tissue, a gap may be formed described.8,21 patient’s American Orthopae- that can make side-to-side suture impossible. The authors Surgical techniques de- dic Foot and Ankle Society present allograft Achilles tendon insertion for reconstruc- scribed in the literature in- (AOFAS)22 score was 23 and tion of chronic degenerative tears. Using Achilles tendon al- clude direct side-to-side his Foot and Ankle Disabil- lograft has the advantage of bone-to-bone fixation, allowing repair and interposition of ity Index (FADI)23 score was rapid incorporation and earlier full weight bearing. autogenous tendon graft for 34.6 preoperatively. -
Hereditary Spastic Paraparesis: a Review of New Developments
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.69.2.150 on 1 August 2000. Downloaded from 150 J Neurol Neurosurg Psychiatry 2000;69:150–160 REVIEW Hereditary spastic paraparesis: a review of new developments CJ McDermott, K White, K Bushby, PJ Shaw Hereditary spastic paraparesis (HSP) or the reditary spastic paraparesis will no doubt Strümpell-Lorrain syndrome is the name given provide a more useful and relevant classifi- to a heterogeneous group of inherited disorders cation. in which the main clinical feature is progressive lower limb spasticity. Before the advent of Epidemiology molecular genetic studies into these disorders, The prevalence of HSP varies in diVerent several classifications had been proposed, studies. Such variation is probably due to a based on the mode of inheritance, the age of combination of diVering diagnostic criteria, onset of symptoms, and the presence or other- variable epidemiological methodology, and wise of additional clinical features. Families geographical factors. Some studies in which with autosomal dominant, autosomal recessive, similar criteria and methods were employed and X-linked inheritance have been described. found the prevalance of HSP/100 000 to be 2.7 in Molise Italy, 4.3 in Valle d’Aosta Italy, and 10–12 Historical aspects 2.0 in Portugal. These studies employed the In 1880 Strümpell published what is consid- diagnostic criteria suggested by Harding and ered to be the first clear description of HSP.He utilised all health institutions and various reported a family in which two brothers were health care professionals in ascertaining cases aVected by spastic paraplegia. The father was from the specific region. -
Outcomes Following Unilateral Selective Dorsal Rhizotomy In
Outcomes and Perioperative Considerations for Unilateral Selective Dorsal Rhizotomy in Children with Spastic Hemiplegia with Pre- and Postoperative Quantitative Gait Analysis Christine Hunt, D.O.1, Nicholas Wetjen, M.D.2, Kenton Kaufman, Ph.D.3, Krista Coleman Wood, P.T., Ph.D.3, Joline Brandenburg, M.D.1, Bradford Landry, D.O.1 1Department of Physical Medicine & Rehabilitation, 2Department of Neurologic Surgery, 3Department of Orthopedic Surgery Mayo Clinic, Rochester, MN Abstract Background & Objectives Methods Results: Postoperative Gait Analysis Discussion Background: Selective dorsal rhizotomy (SDR) is a Background Preoperative Baseline Characteristics Patient 1: Right SDR December 2013 • Pre-SDR, patients undergo an in-depth review of their medical procedure used to improve function, decrease pain and • Several human trials examining outcomes in SDR in children • Patient 1: 6 year old male, spastic right hemiplegia • 62.5% of sensory dorsal rootlets sectioned ( L2 to S1) history and imaging studies, consultation with a physiatrist, reduce spasticity in children and adults with cerebral palsy or neurosurgeon, and orthopedic surgeon, and evaluation with PT with spastic diplegia have been conducted, but there is a • GMFCS Level II • Normalized velocity and stride length stroke. Positive outcomes have been reported by numerous and OT. Testing includes QGA, MRI lumbar spine and brain, paucity of data describing outcomes following SDR for • 12 series of botulinum toxin • Improved hip and knee kinematics and kinetics authors but pediatric -
Muscular Involvement Assessed by MRI Correlates to Motor Function Measurement Values in Oculopharyngeal Muscular Dystrophy
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by RERO DOC Digital Library J Neurol (2011) 258:1333–1340 DOI 10.1007/s00415-011-5937-9 ORIGINAL COMMUNICATION Muscular involvement assessed by MRI correlates to motor function measurement values in oculopharyngeal muscular dystrophy Arne Fischmann • Monika Gloor • Susanne Fasler • Tanja Haas • Rachele Rodoni Wetzel • Oliver Bieri • Stephan Wetzel • Karl Heinimann • Klaus Scheffler • Dirk Fischer Received: 26 October 2010 / Revised: 13 January 2011 / Accepted: 25 January 2011 / Published online: 22 February 2011 Ó Springer-Verlag 2011 Abstract Oculopharyngeal muscular dystrophy (OPMD) distal motor capacity was hardly affected. We observed a is a progressive skeletal muscle dystrophy characterized by high (negative) correlation between the validated clinical ptosis, dysphagia, and upper and lower extremity weak- scores and our visual imaging scores suggesting that ness. We examined eight genetically confirmed OPMD quantitative and more objective muscle MRI might serve as patients to detect a MRI pattern and correlate muscle outcome measure for clinical trials in muscular involvement, with validated clinical evaluation methods. dystrophies. Physical assessment was performed using the Motor Function Measurement (MFM) scale. We imaged the lower Keywords MRI Á Motor function measurement Á extremities on a 1.5 T scanner. Fatty replacement was Outcome measure Á Muscle Á Oculopharyngeal muscular graded on a 4-point visual scale. We found prominent dystrophy Á OPMD affection of the adductor and hamstring muscles in the thigh, and soleus and gastrocnemius muscles in the lower leg. The MFM assessment showed relative mild clinical Introduction impairment, mostly affecting standing and transfers, while Oculopharyngeal muscular dystrophy (OPMD) is a rare, slowly progressive autosomal dominant muscular dystro- Arne Fischmann and Monika Gloor authors are contributed equally to this work. -
Cerebral Palsy the ABC's of CP
Cerebral Palsy The ABC’s of CP Toni Benton, M.D. Continuum of Care Project UNM HSC School of Medicine April 20, 2006 Cerebral Palsy Outline I. Definition II. Incidence, Epidemiology and Distribution III. Etiology IV. Types V. Medical Management VI. Psychosocial Issues VII. Aging Cerebral Palsy-Definition Cerebral palsy is a symptom complex, (not a disease) that has multiple etiologies. CP is a disorder of tone, posture or movement due to a lesion in the developing brain. Lesion results in paralysis, weakness, incoordination or abnormal movement Not contagious, no cure. It is static, but it symptoms may change with maturation Cerebral Palsy Brain damage Occurs during developmental period Motor dysfunction Not Curable Non-progressive (static) Any regression or deterioration of motor or intellectual skills should prompt a search for a degenerative disease Therapy can help improve function Cerebral Palsy There are 2 major types of CP, depending on location of lesions: Pyramidal (Spastic) Extrapyramidal There is overlap of both symptoms and anatomic lesions. The pyramidal system carries the signal for muscle contraction. The extrapyramidal system provides regulatory influences on that contraction. Cerebral Palsy Types of brain damage Bleeding Brain malformation Trauma to brain Lack of oxygen Infection Toxins Unknown Epidemiology The overall prevalence of cerebral palsy ranges from 1.5 to 2.5 per 1000 live births. The overall prevalence of CP has remained stable since the 1960’s. Speculations that the increased survival of the VLBW preemies would cause a rise in the prevalence of CP have proven wrong. Likewise the expected decrease in CP as a result of C-section and fetal monitoring has not happened. -
Effectiveness of Myofascial Release on Spasticity and Lower Extremity
hysical M f P ed l o ic a in n r e u & o R J International Journal of Kumar and Vaidya, Int J Phys Med Rehabil 2014, 3:1 l e a h n a DOI: 10.4172/2329-9096.1000253 o b i t i l a ISSN: 2329-9096i t a n r t i e o t n n I Physical Medicine & Rehabilitation Research Article Open Access Effectiveness of Myofascial Release on Spasticity and Lower Extremity Function in Diplegic Cerebral Palsy: Randomized Controlled Trial Chandan Kumar1* and Snehashri N Vaidya2 1Associate Professor, Smt Kashibai Navale College of Physiotherapy, Narhe, Pune, Maharashtra, India 2MGM’S School of Physiotherapy, Aurangabad, India Abstract Purpose: To find out the effectiveness of Myofascial Release in combination with conventional physiotherapy on spasticity of calf, hamstring and adductors of hip and on lower extremity function in spastic diplegic subjects. Methodology: 30 spastic diplegic subjects of age group 2-8 years were taken by random sampling method from MGM College and other private clinics in Aurangabad. 15 subjects were assigned in each group. Group A: Myofascial release and conventional PT treatment. Group B: conventional PT treatment. Both the groups received training for 4 weeks. Baseline and Post treatment measures of Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS) and Gross Motor Function Test (GMFM-88) were evaluated. Results: Mean difference of MAS and R2 value of MTS in group A was more than group B, for calf, hamstring and adductors, whereas GMFM showed nearly equal improvement in both groups. Conclusion: Overall, it can be concluded from our study that the MFR along with conventional treatment reduces spasticity in calf, hamstring and adductors of hip in spastic diplegic subjects. -
Isolated Tibialis Posterior Muscle Strain: a Rare Sporting Injury
International Journal of Sport, Exercise and Health Research 2020; 4(2): 44-45 Case Report Isolated Tibialis Posterior Muscle Strain: A rare sporting IJSEHR 2020; 4(2): 44-45 © 2020, All rights reserved injury www.sportscienceresearch.com Received: 12-06-2020 Paul Marovic1, Paul Edmond Smith2, Drew Slimmon3 Accepted: 20-08-2020 1 Alfred Hospital, Melbourne, Australia 2 Epworth Medical Imaging, Melbourne, Australia 3 Olympic Park Sports Medicine Centre, Melbourne, Australia Abstract We present the case of an isolated tibialis posterior muscle strain in an Australian Rules Football (AFL) player, an injury not previously described in the medical literature. The elite footballer presented with calf tightness following a game of AFL. The clinical history, examination findings and treatment regime followed a course similar to more typical “calf strains” involving the gastrocnemius and soleus muscles, however Magnetic Resonance Imaging (MRI) revealed a low grade isolated muscle strain of tibialis posterior. The only inciting factor was the use of new football boots. This novel case will alert radiologists and sports physicians to a new potential source of calf pain in athletes. Keywords: Tibialis Posterior, Strain, Calf, Muscle. INTRODUCTION Pathology of the tibialis posterior tendon, from chronic tibialis posterior dysfunction leading to acquired pes planus, to acute rupture in forced eversion injuries, are well documented [1,2]. Tibialis posterior muscle strains are rare with only one published case in the chiropractic literature, diagnosed on clinical grounds in a triathlete and supported by an ultrasound demonstrating “limited inflammation” in the calf [3]. CASE REPORT We present the case of a 27-year-old right foot dominant professional male AFL player who presented with right calf pain following a game of AFL football. -
Cerebral Palsy and Epilepsy in Children: Clinical Perspectives on a Common Comorbidity
children Article Cerebral Palsy and Epilepsy in Children: Clinical Perspectives on a Common Comorbidity Piero Pavone 1 , Carmela Gulizia 2, Alice Le Pira 1, Filippo Greco 1, Pasquale Parisi 3 , Giuseppe Di Cara 4, Raffaele Falsaperla 5, Riccardo Lubrano 6, Carmelo Minardi 7 , Alberto Spalice 8 and Martino Ruggieri 9,* 1 Unit of Clinical Pediatrics, Department of Clinical and Experimental Medicine, AOU “Policlinico”, PO “G. Rodolico”, University of Catania, 95123 Catania, Italy; [email protected] (P.P.); [email protected] (A.L.P.); [email protected] (F.G.) 2 Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; [email protected] 3 NESMOS Department of Pediatrics, Sapienza University of Rome, Sant’Andrea University Hospital, 00161 Rome, Italy; [email protected] 4 Department of Pediatrics, University of Perugia, 06132 Perugia, Italy; [email protected] 5 Neonatal Intensive Care Unit (NICU), Neonatal COVID-19 Center, AOU “Policlinico”, PO San Marco, University of Catania, 95123 Catania, Italy; [email protected] 6 Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria, Neonatologia, Ospedale Santa Maria Goretti, Polo di Latina, 04010 Latina, Italy; [email protected] 7 Department of Anaesthesia and Intensive Care, University Hospital “G. Rodolico” of Catania, 95123 Catania, Italy; [email protected] 8 Child Neurology Division, Department of Pediatrics, -
Cerebral Palsy
Cerebral Palsy Cerebral palsy encompasses a group of non-progressive and non-contagious motor conditions that cause physical disability in various facets of body movement. Cerebral palsy is one of the most common crippling conditions of childhood, dating to events and brain injury before, during or soon after birth. Cerebral palsy is a debilitating condition in which the developing brain is irreversibly damaged, resulting in loss of motor function and sometimes also cognitive function. Despite the large increase in medical intervention during pregnancy and childbirth, the incidence of cerebral palsy has remained relatively stable for the last 60 years. In Australia, a baby is born with cerebral palsy about every 15 hours, equivalent to 1 in 400 births. Presently, there is no cure for cerebral palsy. Classification Cerebral palsy is divided into four major classifications to describe different movement impairments. Movements can be uncontrolled or unpredictable, muscles can be stiff or tight and in some cases people have shaky movements or tremors. These classifications also reflect the areas of the brain that are damaged. The four major classifications are: spastic, ataxic, athetoid/dyskinetic and mixed. In most cases of cerebral palsy, the exact cause is unknown. Suggested possible causes include developmental abnormalities of the brain, brain injury to the fetus caused by low oxygen levels (asphyxia) or poor circulation, preterm birth, infection, and trauma. Spastic cerebral palsy leads to increased muscle tone and inability for muscles to relax (hypertonic). The brain injury usually stems from upper motor neuron in the brain. Spastic cerebral palsy is classified depending on the region of the body affected; these include: spastic hemiplegia; one side being affected, spastic monoplegia; a single limb being affected, spastic triplegia; three limbs being affected, spastic quadriplegia; all four limbs more or less equally affected.