title: Dynamic equinus with hindfoot valgus in children with hemiplegia.
abstract: In children with hemiplegia, it is important to distinguish between equinus with hindfoot varus (equinovarus) or valgus (equinovalgus). Premature onset of medial gastrocnemius (GM) EMG in individuals with equinus is well documented. Premature onset of Peroneus longus (PL) EMG has been described in neurologically impaired adults with equinovalgus, but not in children. Our aim was to record the onset of PL and GM activity on the hemiplegic side of children with equinovalgus deformity. Fifteen children GMFCS 1 (3.8 yrs ± 2) with hemiplegia had a goniometric assessment of passive ankle range of motion and assessment of ankle function from video and surface EMG recording during gait. The clinical and video observations were used to determine the equinovalgus, as defined by Wren, at initial contact (IC). The premature onset of muscle activity was normalised as a swing (SW) percentage prior to IC of the following stance (ST). A paired T-test compared the onset of muscle activity between PL and GM. The ankle passive dorsiflexion was 13° ± 12° (hemiplegic side) versus 18° ± 10° (non-involved side) (p<0.05). For the non-involved limb, the onset of GM activity was at 14% of the gait cycle (midstance), the onset of PL activity was at 19% (p<0.05). For the hemiplegic limb with equinovalgus, there was a premature onset activity of PL (-24%) and GM(-8%) (p<0.001). On the non involved side, the onset of PL activity occurred, as in adults, after the onset of GM activity, during ST. On the hemiplegic side, there was no triceps surae contracture and the onset of PL activity occurred prior to the onset of GM activity, during terminal SW. This study confirmed the overactivity of PL in hemiplegic children with equinovalgus.
authors.affiliation: Laboratoire de la Marche, service de Chirurgie Orthopédique Pédiatrique, CHU Timone Enfants, Aix-Marseille Univ, 13385 Marseille, France. christophe.boulay@ap-hm.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Boulay
authors.forename: Vincent
authors.initials: V
authors.lastname: Pomero
authors.forename: Elke
authors.initials: E
authors.lastname: Viehweger
authors.forename: Yann
authors.initials: Y
authors.lastname: Glard
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Castanier
authors.forename: Guillaume
authors.initials: G
authors.lastname: Authier
authors.forename: Cécile
authors.initials: C
authors.lastname: Halbert
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Jouve
authors.forename: Brigitte
authors.initials: B
authors.lastname: Chabrol
authors.forename: Gérard
authors.initials: G
authors.lastname: Bollini
authors.forename: Michel
authors.initials: M
authors.lastname: Jacquemier
mesh_terms: D000222:Adaptation, Physiological; D000843:Ankle Joint / Q000503:physiopathology; D002547:Cerebral Palsy / Q000150:complications* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004576:Electromyography; D004863:Equinus Deformity / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000175:diagnosis* / Q000209:etiology; D006215:Hallux Valgus / Q000503:physiopathology; D006429:Hemiplegia / Q000150:complications* / Q000151:congenital; D006801:Humans; D007223:Infant; D008297:Male; D009119:Muscle Contraction / Q000502:physiology; D009128:Muscle Spasticity / Q000503:physiopathology; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D018570:Risk Assessment; D012720:Severity of Illness Index