Surgery for equinovarus deformity in Friedreich's ataxia improves mobility and independence.
Friedreich's ataxia results in morbidity because of many factors; progressive equinovarus deformity is one of these. We studied the risk factors and incidence of this deformity. We sought to assess whether surgical management of fixed equinovarus deformity leads to functional improvement. Thirty-six patients with Friedrich's ataxia were assessed for this deformity. These patients were treated by splinting, botulinum toxin Type A injection, and surgery, as indicated by the severity, followed by an ongoing rehabilitation program. The effect of surgery was assessed using subscales of the Barthel index and functional independence measure. Severe foot deformities in which either surgery or botulinum toxin injection was recommended correlated with current age, years since disease onset, and years that the patient required a wheelchair for mobility, but not with the GAA repeat size or age at disease onset. Function and mobility were improved after surgery compared with a similar period before surgery. Three of seven patients who had surgery had significant complications. Aggressive management of foot deformities should be considered, and active measures to prevent permanent foot deformities should be pursued to maximize quality of life and independence of patients with Friedreich's ataxia.


METHODS
Therapeutic study, Level IV (case series-no, or historical control group).
Delatycki
Martin B
MB
Bruce Lefroy Centre for Genetic Health Research, Genetic Health Services Victoria, Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, Australia. martin.delatycki@ghsv.org.au
Holian
Annette
A
Corben
Louise
L
Rawicki
H Barry
HB
Blackburn
Christine
C
Hoare
Brian
B
Toy
Melanie
M
Churchyard
Andrew
A
D000203:Activities of Daily Living; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D004863:Equinus Deformity / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery*; D005621:Friedreich Ataxia / Q000150:complications*; D006801:Humans; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D013165:Splints; D016896:Treatment Outcome
D019274:Botulinum Toxins, Type A