Background
Case presentation
Treatment | Age (years) | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
6 | 6.5 | 7 | 7.5 | 8 | 8.5 | 9 | 9.5 | 10 | 10.5 | 11 | 11.5 | 12 | 12.5 | ||
BoNT-A | Hamstrings (bilateral) | * | * | * | * | * | * | * | * | * | * | ||||
Gastrocnemius (right) | * | * | * | * | * | * | * | * | * | * | |||||
Gastrocnemius (left) | * | * | * | * | |||||||||||
Psoas (bilateral) | * | * | |||||||||||||
Rectus femoris (right) | * | ||||||||||||||
Casting | Long leg (bilateral) | * | * | * | * | * | * | * | * | ||||||
Serial (right ankle) | * | * | * |
Assessments
Outcomes
Physical examination
Passive range of motion | Right | Left |
---|---|---|
Hip extension | 10–20° flexiona
| 10–20° flexiona
|
Hip internal rotation/external rotation | 70–75°/45–70° | 65–80°/40–55°b
|
Hip abduction | 30–45° | 20–40° |
Popliteal angle (full knee extension = 0°) | 65–80° | 60–75° |
Knee extension | 5–10° flexion | 0–5° hyperextensionc
|
Ankle dorsiflexion (knee extended) | 0–10° | 0–10° |
Ankle dorsiflexion (knee flexed) | 5–20° | 5–20° |
Gait analysis: temporal-spatial parameters, kinematics, and electromyography
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Pelvis: His pelvis was held in a posture of rotation to the left with left upward pelvic obliquity throughout the gait cycle. There was “double-bump” pelvic anteversion during the gait cycle.
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Hip: Hip flexion and extension were nearly within normal limits (WNL) through the gait cycle. His right hip rotated internally during stance. His left hip was internally rotated through the gait cycle, secondary to the retracted pelvis on the ipsilateral side. His right hip was abducted and his left hip was adducted with respect to the oblique pelvis.
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Knee: At initial contact, his knees were flexed, right more so than left. There was reduced knee extension in midstance, right more so than left. Peak knee flexion during swing was reduced on his left, and reduced and delayed on his right. His tibiae were externally rotated.
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Ankle: His ankles were slightly plantar flexed at initial contact, with peak dorsiflexion generally occurring in loading response. His right foot progression angle was WNL, while his left foot progression angle was slightly internally rotated during stance.