title: Surgical Treatment Guidelines for Digital Deformity Associated With Intrinsic Muscle Spasticity (Intrinsic Plus Foot) in Adults With Cerebral Palsy.
abstract: Intrinsic plus foot deformity has primarily been associated with cerebral palsy and involves spastic contracture of the intrinsic musculature with resultant toe deformities. Digital deformity is caused by a dynamic imbalance between the intrinsic muscles in the foot and extrinsic muscles in the lower leg. Spastic contracture of the toes frequently involves curling under of the lesser digits or contracture of the hallux into valgus or plantarflexion deformity. Patients often present with associated pressure ulcers, deformed toenails, shoe or brace fitting challenges, and pain with ambulation or transfers. Four different patterns of intrinsic plus foot deformity have been observed by the authors that likely relate to the different patterns of muscle involvement. Case examples are provided of the 4 patterns of intrinsic plus foot deformity observed, including global intrinsic plus lesser toe deformity, isolated intrinsic plus lesser toe deformity, intrinsic plus hallux valgus deformity, and intrinsic plus hallux flexus deformity. These case examples are presented to demonstrate each type of deformity and our approach for surgical management according to the contracture pattern. The surgical approach has typically involved tenotomy, capsulotomy, or isolated joint fusion. The main goals of surgical treatment are to relieve pain and reduce pressure points through digital realignment in an effort to decrease the risk of pressure sores and allow more effective bracing to ultimately improve the patient's mobility.
authors.affiliation: Director, Foot and Ankle Surgical Residency Program, Regions Hospital/HealthPartners Institute for Education and Research, St. Paul, MN.
authors.forename: Troy J
authors.initials: TJ
authors.lastname: Boffeli
authors.affiliation: Staff Surgeon, Foot and Ankle Surgical Residency Program, Regions Hospital/HealthPartners Institute for Education and Research, St. Paul, MN. Electronic address: rachel.c.collier@healthpartners.com.
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Collier
mesh_terms: D000328:Adult; D002547:Cerebral Palsy / Q000150:complications* / Q000175:diagnosis; D003286:Contracture / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D005531:Foot Deformities, Acquired / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D037801:Hammer Toe Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods*; D011859:Radiography; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: hallux valgus; hammertoe; intrinsic plus foot deformity; minimally invasive; spastic deformity