Calcaneal Gait in Clubfoot after Posteromedial Release –Report of a Case with Motion Analysis and Dynamic EMG

A boy aged 4 years and 6 months was referred for further evaluation of his ambu-latory ability under diagnosis of status after correction of bilateral clubfeet. Postero-medial soft-tissue release with Achilles tendon lengthening on both feet were done around the age of one year. He walked independently but became tired quickly rela-tive to other children of the same age. A flat-foot gait was noticed clinically. Motion analysis and dynamic electromyography were performed to evaluate the functional deficits. The gait cycle was normal. The cadence and velocity were slightly outside normal limits on the small side. Calcaneal gait was demonstrated by increased dorsi-flexion of the ankle in late stance. The force curve was compatible with a calcaneal gait that was manifested by a diminished second peak on the vertical force curve, and di-minished fore-aft-shear amplitude. AP and lateral radiographs showed no calcaneal deformity. The passive range of motion of the ankles showed no excessive ankle dorsi-flexion. The muscle power of gastrocnemius was slightly weaker(+3/+4). When asked to rise his heels, he had to bend his knees in order to accomplish this. The dynamic electromyography revealed that the efforts and timing of gastrocnemius muscle were relatively normal or only slightly out of phase. The most pronounced finding was continuous overactivity of the anterior tibial muscle. It was postulated that not only the weakness of the gastrocnemius muscle butalso the spasticity of the anterior tibial muscle contributed to calcaneal gait and easy fatigue of this boy. The pathomechanics of this functional deficit were well demonstrated in motion analysis and dynamic electromyographic tests.

並列關鍵字

Clubfoot ； Motion analysis ； Dynamic electromyography ； Calcaneal gait ； Posteromedial release

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