Leg muscle hypoplasia of unknown origin: Treatment particularities in Physical and Rehabilitation Medicine (a case report)
Dr Soumaya BOUDOKHANEa, Dr Amine KALIIa, Dr Houda MIGAOUa, Dr Sana SALAHa, Dr Anis JELLADa, Dr Anis JELLADa, Dr Zohra BEN SALAH FRIHa
a CHU Fattouma Bourguiba de Monastir-Université de Monastir
Restoration of muscle function and orthopedic state is a crucial step in the course of treated foot deformities in infants including talipes equinovarus. Some steps of the treatment cannot be done in cases of paralysis of leg muscles.
It’s a case of an infant that was sent us in the 16th day of life to take care of a deformation of the right foot. On examination, we found a talipes equinovarus with an amyotrophy of the muscles of the posterior compartment of the leg, the rest of the examination was without abnormalities. Ultrasound concluded to posterior, anterior and lateral leg muscle hypoplasia. Electromyographic examination performed at 4 months of age showed an absent electromyogram trace on medial femoral nerve and common fibular nerve. Ponseti method was used, followed by a specific rehabilitation program (mobilization+ active rehabilitation) with a posture equipment (derotation brace). The orthopedic outcome was satisfying. He acquired walking at the age of 14 months with a stepping and internal rotation of the tibial segment, which was stabilized by a walking brace. Ultrasound monitoring performed monthly showed a gradual improvement in muscle atrophy of the leg, but without a motor recovery.
The particularity of our clinical case is a complete agenesis of the leg muscles with a nerve agenesis. Nevertheless we used the Ponseti method followed by active rehabilitation. Orthopedic and functional result was satisfying. Cases reported in the literature of paralytic congenital talipes equinovarus were treated with tendon transfer, and in our case this indication was difficult.