3 types of genu recuravatum External rotary deformity (ERD) Internal rotatory deformity (IRD) Non-rotatory deformity (NRD) - Brace or tape the knee along with providing muscle balance correction. - Gait training - Proprioceptive training to increase your balance, agility, strength, coordination, and to help prevent further injuries. Find the cause and treat according.
Treatment for Genu Recurvatum If a patient does not have an associated cruciate ligament and/or collateral knee injury present, the usual treatment is to attempt a rehabilitation program to see if the patient can improve their overall quadriceps strength to compensate for the symptomatic knee hyperextension. If this does not work, then possibly a biplanar proximal tibial osteotomy, where the patient’s posterior tibial slope is increased, may be indicated. While these are extensive surgeries, they have been well documented to decrease knee hyperextension and allow patients to return to a high functioning level. Our treatment for isolated genu recurvatum is a proximal tibial anteromedial or anterolateral osteotomy that increases the patient’s posterior tibial slope. These surgeries have been found to be very effective in decreasing a patient’s knee hyperextension and returning them to increased activities after the osteotomy heals.
What is the age of patient. As genu recurvatum may be congenital and acquired. In Genu recurvatum excessive extension occurs in tobiofemoral joint. Swedish knee brace around knee joint and dynamic AFO for support. Stretching of triceps surae. Strengthening of hip extensors,Quadriceps,hamstrings. Stretching of ikuo psoas. Trunk control also very important. Cocontraction of quadriceps and hamstrings. Symmetrical weight bearing is very important. For pain cold,elevation of limb. Strengthening of dorsiflexors and evertors of ankle also important.
Main causes of Genu Recurvatum Include : A defined disorder of the connective tissue Laxity of the knee ligaments Instability of the knee joint due to ligaments and joint capsule injuries Irregular alignment of the femur and tibia A deficit in the joints A discrepancy in lower limb length Certain diseases: Cerebral Palsy, Multiple Sclerosis, Muscular Dystrophy Birth defect/congenital defect
Physiotherapy treatment like stretching the triceps surae, strengthening of hip extensor muscles, quadriceps muscle, proper co-contraction of quadriceps and hamstring muscles, stretching of iliopsoas muscle and developing efficient trunk control helps in overcoming genu recurvatum problem
Sometimes use of Swedish knee brace around knee joint and dynamic Ankle Foot Orthosis (AFO) helps in symmetrical weight bearing thereby reducing balance and incoordination issues.
Strengthening of dorsiflexors and evertors of ankle helps in decreasing the effects of equinovarus (inward deviated foot) deformity thereby reducing knee hyperextension.
Maintenance of arches is utmost important while managing genu recurvatum as flat foot and equino varus deformity has a direct influence on knee joint.
Symptoms of Genu Recurvatum: Knee giving way into hyperextension Difficulty with endurance activities Pinching in the front of the knee
Heel lift, taping to prevent hyperextension Single leg balance Mini squats, Step ups, Lunges, Jump landings Gait training with bent knee.
Cases that would interest you
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12 yr old boy with progressive weakness in all four limb and dysarthia.Dr. Ramesh Kumbhkar1 Like14 Answers
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What is foot drop Foot drop is a gait abnormality in which the dropping of the forefoot happens due to weakness, irritation or damage to the common fibular nerve including the sciatic nerve, or paralysis of the muscles in the anterior portion of the lower leg. It is usually a symptom of a greater problem, not a disease in itself. Foot drop is characterized by inability or impaired ability to raise the toes or raise the foot from the ankle (dorsiflexion). Foot drop may be temporary or permanent, depending on the extent of muscle weakness or paralysis and it can occur in one or both feet. In walking, the raised leg is slightly bent at the knee to prevent the foot from dragging along the ground. Foot drop can be caused by nerve damage alone or by muscle or spinal cord trauma, abnormal anatomy, toxins, or disease. Toxins include organophosphate compounds which have been used as pesticides and as chemical agents in warfare. The poison can lead to further damage to the body such as a neurodegenerative disorder called organophosphorus induced delayed polyneuropathy. This disorder causes loss of function of the motor and sensory neural pathways. In this case, foot drop could be the result of paralysis due to neurological dysfunction. Diseases that can cause foot drop include trauma to the posterolateral neck of fibula, stroke, amyotrophic lateral sclerosis, muscular dystrophy, poliomyelitis, Charcot Marie Tooth disease, multiple sclerosis, cerebral palsy, hereditary spastic paraplegia, Guillain–Barré syndrome, and Friedreich's ataxia. It may also occur as a result of hip replacement surgery or knee ligament reconstruction surgery. Signs and symptom Human lower leg anatomy Foot drop is characterized by steppage gait.While walking, people suffering the condition drag their toes along the ground or bend their knees to lift their foot higher than usual to avoid the dragging. This serves to raise the foot high enough to prevent the toe from dragging and prevents the slapping. To accommodate the toe drop, the patient may use a characteristic tiptoe walk on the opposite leg, raising the thigh excessively, as if walking upstairs, while letting the toe drop. Other gaits such as a wide outward leg swing (to avoid lifting the thigh excessively or to turn corners in the opposite direction of the affected limb) may also indicate foot drop. Patients with painful disorders of sensation (dysesthesia) of the soles of the feet may have a similar gait but do not have foot drop. Because of the extreme pain evoked by even the slightest pressure on the feet, the patient walks as if walking barefoot on hot sand. Pathophysiology The causes of foot drop, as for all causes of neurological lesions, should be approached using a localization-focused approach before etiologies are considered. Most of the time, foot drop is the result of neurological disorder; only rarely is the muscle diseased or nonfunctional. The source for the neurological impairment can be central (spinal cord or brain) or peripheral (nerves located connecting from the spinal cord to an end-site muscle or sensory receptor). Foot drop is rarely the result of a pathology involving the muscles or bones that make up the lower leg. The anterior tibialis is the muscle that picks up the foot. Although the anterior tibialis plays a major role in dorsiflexion, it is assisted by the fibularis tertius, extensor digitorum longus and the extensor halluces longus. If the drop foot is caused by neurological disorder all of these muscles could be affected because they are all innervated by the deep fibular (peroneal) nerve, which branches from the sciatic nerve. The sciatic nerve exits the lumbar plexus with its root arising from the fifth lumbar nerve space. Occasionally, spasticity in the muscles opposite the anterior tibialis, the gastrocnemius and soleus, exists in the presence of foot drop, making the pathology much more complex than foot drop. Isolated foot drop is usually a flaccid condition. There are gradations of weakness that can be seen with foot drop, as follows: 0=complete paralysis, 1=flicker of contraction, 2=contraction with gravity eliminated alone, 3=contraction against gravity alone, 4=contraction against gravity and some resistance, and 5=contraction against powerful resistance (normal power). Foot drop is different from foot slap, which is the audible slapping of the foot to the floor with each step that occurs when the foot first hits the floor on each step, although they often are concurrent. Treated systematically, possible lesion sites causing foot drop include (going from peripheral to central): Neuromuscular disease;Peroneal nerve (common, i.e., frequent) —chemical, mechanical, disease;Sciatic nerve—direct trauma, iatrogenic;Lumbosacral plexus;L5 nerve root (common, especially in association with pain in back radiating down leg);Cauda equina syndrome, which is cause by impingement of the nerve roots within the spinal canal distal to the end of the spinal cord;Spinal cord (rarely causes isolated foot drop) —poliomyelitis, tumor;Brain (uncommon, but often overlooked) —stroke, TIA, tumor;Genetic (as in Charcot-Marie-Tooth Diseaseand hereditary neuropathy with liability to pressure palsies);Nonorganic causes. If the L5 nerve root is involved, the most common cause is a herniated disc. Other causes of foot drop are diabetes (due to generalized peripheral neuropathy), trauma, motor neuron disease (MND), adverse reaction to a drug or alcohol, and multiple sclerosis. Gait cycle Drop foot and foot drop are interchangeable terms that describe an abnormal neuromuscular disorder that affects the patient's ability to raise their foot at the ankle. Drop foot is further characterized by an inability to point the toes toward the body (dorsiflexion) or move the foot at the ankle inward or outward. Therefore, the normal gait cycle is affected by the drop foot syndrome. The normal gait cycle is as follows: Swing phase (SW): The period of time when the foot is not in contact with the ground. In those cases where the foot never leaves the ground (foot drag), it can be defined as the phase when all portions of the foot are in forward motion.Initial contact (IC): The point in the gait cycle when the foot initially makes contact with the ground; this represents the beginning of the stance phase. It is suggested that heel strike not be a term used in clinical gait analysis as in many circumstances initial contact is not made with the heel. Suggestion: Should use foot strike.Terminal contact (TC): The point in the gait cycle when the foot leaves the ground: this represents the end of the stance phase or beginning of the swing phase. Also referred to as foot off. Toe-off should not be used in situations where the toe is not the last part of the foot to leave the ground. The drop foot gait cycle requires more exaggerated phases. Drop foot SW: If the foot in motion happens to be the affected foot, there will be greater flexion at the knee to accommodate the inability to dorsiflex. This increase in knee flexion will cause a stair-climbing movement.Drop foot IC: Initial contact of the foot that is in motion will not have normal heel-toe foot strike. Instead, the foot may either slap the ground or the entire foot may be planted on the ground all at once.Drop foot TC: Terminal contact that is observed in patients that have drop foot is quite different. Since patients tend to have weakness in the affected foot, they may not have the ability to support their body weight. Often, a walker or cane will be used to assist in this aspect. Drop Foot is the inability to dorsiflex, evert, or invert the foot. So when looking at the Gait cycle, the part of the gait cycle that involves most dorsiflexion action would be Heel Contact of the foot at 10% of Gait Cycle, and the entire swing phase, or 60-100% of the Gait Cycle. This is also known as Gait Abnormalities. DiagnosisEdit Initial diagnosis often is made during routine physical examination. Such diagnosis can be confirmed by a medical professional such as a neurologist, orthopedic surgeon or neurosurgeon. A person with foot drop will have difficulty walking on his or her heels because he will be unable to lift the front of the foot (balls and toes) off the ground. Therefore, a simple test of asking the patient to dorsiflex may determine diagnosis of the problem. This is measured on a 0-5 scale that observes mobility. The lowest point, 0, will determine complete paralysis and the highest point, 5, will determine complete mobility. There are other tests that may help determine the underlying etiology for this diagnosis. Such tests may include MRI, MRN, or EMG to assess the surrounding areas of damaged nerves and the damaged nerves themselves, respectively. The nerve that communicates to the muscles that lift the foot is the peroneal nerve. This nerve innervates the anterior muscles of the leg that are used during dorsi flexion of the ankle. The muscles that are used in plantar flexion are innervated by the tibial nerve and often develop tightness in the presence of foot drop. The muscles that keep the ankle from supination (as from an ankle sprain) are also innervated by the peroneal nerve, and it is not uncommon to find weakness in this area as well. Paraesthesia in the lower leg, particularly on the top of the foot and ankle, also can accompany foot drop, although it is not in all instances. A common yoga kneeling exercise, the Varjrasana has, under the name "yoga foot drop," been linked to foot drop. Vajrasana yoga foot drop --- Yoga foot drop is a kind of drop foot, a gait abnormality. It is caused by a prolonged sitting on heels, a common yoga position of vajrasana. The name was suggested by Joseph Chusid, MD, in 1971, who reported a case of foot drop in a student who complained about increasing difficulty to walk, run, or climb stairs. The cause was thought to be injury to the common peroneal nerve, which is compressed and thereby deprived of blood flow while kneeling. Yoga foot drop is a potential adverse effect of yoga, allegedly unmentioned by yoga teachers and booksDr. Rina Upadhyay8 Likes13 Answers
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10 m male with microcephaly, seizures , spastic paraplegia, optic atrophy on the left , pneumonia one month backDr. Nihaal Reddy1 Like15 Answers
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8yr boy came with Subnormal intelligence and walking difficultly... Pt was near term (born 7 d before EDD), hospital delivered with no significant perinatal event, SGA, antenatal history normal. A/t father no feeding difficulty or jaundice post nataly, first thing they noticed was child not achieving milestones in time like neck holding, sitting, speaking... ie GDD. Then he consulted various practitioners and told to be case of CP and muscle relaxants given. Pt never had convulsion. Pt started walking after 2yrs and speaking monosyllables.. at present he walk unassisted with abnormal gait keeping feet in equinus position and reply to basic question but overall low IQ, he keep smiling in bw interaction. O/e OFC 45cm, heterochromic iris, tone slightly increased, DTR brisk, plantar extensor, contractures felt at both tendoachillis with varus deformity in both knees... CT and X rays done attached. No h/o convulsion so far... Discuss ur opinions and further necessary tests....Dr. Manish Verma4 Likes16 Answers
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A 2 yrs old male pt having neck muscles weakness, Delayed developmental milestones, his cognition is good. since neck control not achieved like wise sitting is not achieved. Here I am attaching his photos and reports. What will be the diagnosis as well as management?Dipti Vanzara7 Likes16 Answers