Orthopedic Interventions for Foot Deformities in Non-Ambulant People with Duchenne Muscular Dystrophy: A Retrospective Study on Indications, Post-Operative and Long-Term Outcomes

Article type: Research Article

Authors: Houwen-van Opstal, Saskia L.S.^{a; *} | Timmer, Amity C.^a | Ten Ham, A.M.^b | Hosman, Allard J.F.^c | Willemsen, Michel A.A.P.^d | de Groot, Imelda J.M.^a

Affiliations: [a] Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, The Netherlands | [b] Department of Orthopedics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, The Netherlands | [c] Department of Orthopedics, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, The Netherlands | [d] Department of Paediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, The Netherlands

Correspondence: [*] Correspondence to: Saskia L.S. Houwen-van Opstal, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands. Tel.: +31643497726; E-mail: Saskia.Houwen@Radboudumc.nl.

Abstract: Background:Progressive equinovarus deformities are common in people with Duchenne Muscular Dystrophy (DMD); they may provoke pain, pressure spots, cause problems with wearing footwear, and may lead to an unstable sitting position. Objective:Explore indications and compare complications and long-term outcomes after soft tissue and osseous interventions in people with DMD. Methods:Retrospective, monocenter, longitudinal study. Data on indications, equinus and varus deformity before and after surgery, wound healing problems, ‘pain’, edema, and long-term outcomes were collected from medical files. Soft tissue interventions were compared with osseous interventions. Results:From a series of 18 patients, data on 32 surgical interventions and 169 follow-up visits were analyzed. ‘Footrest placement’ was the most frequent surgical indication, followed by pain. Osseous interventions were performed in older patients with rigid deformities. Directly after surgery remaining deformities were reported after soft tissue interventions (18 %), no remaining deformities were reported after osseous interventions. Pain and edema were frequently present, especially after osseous surgery. Longitudinal follow-up showed that surgical interventions could lead to a neutral foot for a for more than 3 years on average years. Relapses of foot deformity occurred, especially the recurrence of varus deformity after osseous interventions. Conclusions:Surgical interventions can successfully lead to a neutral foot position for for more than 3 years on average. Soft tissue interventions appear to be superior to osseous corrections, considering the varus recurrence period and complications, and may be considered when feet are still (partly) correctable. Pain management and edema prevention should be anticipated before surgery. Future research on patient reported outcomes as well as evaluating the outcome of the initial indication is needed to further identify benefits.

Keywords: Duchenne muscular dystrophy, foot deformity, orthopedic surgery, talectomy, tenotomy, arthrodesis, pain, edema

DOI: 10.3233/JND-220803

Journal: Journal of Neuromuscular Diseases, vol. 9, no. 5, pp. 641-648, 2022