Complex Foot and Long Bone Deformity Correction, Cerebral Palsy, Limb Lengthening

Disfigurements can occur in any part of the human body, including the foot, which is most commonly referred to as Multiplanar deformities or complex foot deformities. These deformities can appear distinct from the rest of the body and can be caused by injuries, genetic disorders, or complications during childbirth. Commonly, these deformities, affecting the legs, hands, spine, or ankles, include feet with poor soft tissue coverage, cases that have recurred or been neglected, and feet with associated issues such as leg length discrepancy, deformities of the lower leg, and osteomyelitis.

Correcting these deformities remains a significant surgical challenge worldwide despite advances in surgical techniques. Limb length discrepancy, where one limb is shorter than its counterpart, can result from various factors which can be categorised into three groups:

1. Since birth,
2. Childhood diseases or injuries that impair or damage growth plates,
3. Broken bones that cause the ends of the bones to become shorter.

If the difference in leg length is minor, a heel or shoe lift may be added to the footwear to provide additional height and even out the length of the legs, improving comfort while walking or standing. In cases of significant leg length differences, limb lengthening surgery may be necessary to correct the issue. It is essential to consult with the top orthopaedicians and surgeons in Bangalore at Apollo Hospitals, Karnataka, and seek treatment to prevent the recurrence of musculoskeletal disorders.

If the deformities occur during childhood, correction should be performed as soon as possible to prevent secondary bony changes or the development of permanent compensatory deformities. If complex deformities persist into adulthood, they may indicate a highly durable deformity with scarring, tight soft tissue, pressure ulcers, and dense callous structures that are not amenable to further extensive open surgery.

Cerebral Palsy

Cerebral Palsy (CP) is a class of neurological disorders that affect motor and cognitive abilities. The term ‘cerebral’ is derived from the word ‘cerebrum,’ which refers to the portion of the brain responsible for motor control. ‘Palsy’ is derived from the term ‘paralysis,’ which signifies the inability to move certain areas of the body voluntarily. It can lead to issues with posture, walking style, muscular tone, and movement coordination.

Symptoms of Cerebral Palsy

The effects of cerebral palsy vary from person to person. Some individuals with it may have trouble walking and sitting, while others may struggle with gripping objects. The symptoms also depend on the specific part of the brain that has been affected. Some of the most common symptoms include:

• Delayed motor skills, such as the inability to roll over, sit up on one’s own, or crawl
• Muscle tone variations, such as overly loose or rigid muscle tone.
• Associated neurological conditions, like seizures, mental health issues, and blindness.
• Sudden and excessive drooling, along with difficulties in swallowing.
• Walking difficulties.
• Speech delays and difficulties.
• Spasticity – a condition characterised by rigid muscles and overactive reflexes.

Screening and Diagnosis for Cerebral Palsy

Early diagnosis of Cerebral Palsy is essential for the health and well-being of children and their family members. There are several steps that can be taken to accurately diagnose Cerebral Palsy:

• Developmental Monitoring – Developmental screening refers to the process of monitoring a child’s development and growth over a period of time.
• Developmental Screening – During developmental screening, a short test is administered to determine if the child has any specific developmental delays, such as motor or movement delays.
• Developmental Evaluation – The purpose of a developmental assessment is to determine the type of disorder a child has.

Treatment

There’s no cure for Cerebral Palsy, but there are treatments that can help people with the condition live better lives. It’s important to start a treatment plan as soon as possible. Common treatments include medication, surgery, braces, and physical, occupational, and speech therapy. There’s no one right treatment for everyone with Cerebral Palsy, so it’s important to talk to the doctor about the treatment plan and all the potential risks and benefits.

Limb Lengthening Surgery

This is achieved by gradually increasing the length of the bones and the soft tissues (such as skin, muscles, and nerves). The process of lengthening is accomplished by the body’s ability to create new bone, as well as by the soft tissue, ligaments and blood vessels surrounding and supporting the bone. The duration of the lengthening process is usually several months. Additionally, limb lengthening may be accompanied by gradual or acute deformation correction. Procedures for limb lengthening may be suggested by the physician if there is a deformity in the lengths of the hands and feet and if there is Cerebral Palsy.

When should limb lengthening be taken into account?

Patients who do not wish to have their legs shortened or undergo epiphysis in cases of discrepancies less than 2 inches (5 cm) and in cases of discrepancies greater than 5 inches (9 cm) are advised to opt for limb lengthening. However, this procedure is more complex and demanding than shortening and may need to be combined with either epiphysis or shortening in order to reduce the amount of length required.

Limb Lengthening Procedure

Before the Surgery

Prior to a patient’s surgical procedure, the physician will conduct an X-ray of the bone and a measurement of the bone. These examinations assist the provider in determining the desired length of the bone. Generally, the patient can anticipate a growth of approximately 2 inches per surgery. On the day of the operation, the provider will administer general anaesthesia to the patient, which induces sleep. Generally, the patient remains in the hospital for approximately three days following the operation. If the surgery is to lengthen a leg bone, the patient may not be able to walk immediately and may require the use of a chair, crutches, or other aids.

During the Surgery

There are two main phases to a limb lengthening surgery.

• An osteotomy is a surgical procedure in which the affected bone is divided into two sections.
• A limb lengthening device is attached to the two sections of the bone.

The surgeon will use pins or wires to attach a thin metal frame called an External fixator to the bones. Most of the device is outside of the body. The newer option is an Internal rod, which is a screw-shaped device that the surgeon inserts into the bone. It’s not visible from the outside.

After the Surgery

The patient will remain in the hospital for a period of several days while recuperating. Upon discharge from the hospital, the provider will provide the patient with instructions on how to utilise their limb lengthening device. If an individual has an external device, the pin sites must be cleaned daily to prevent infection. Conversely, if an individual has an internal device, the surgical incisions must be kept clean until healing is necessary.

Complications Associated with Limb Lengthening Surgery

• A bone that’s not hard enough to hold together properly.
• A bone that does not meet the required length.
• Infections at the site of the incision or in the bone.
• Joint or muscle stiffness in the extended arm or leg.
• Muscle or nerve damage.

The board-certified and highly experienced medical professionals at Apollo Hospitals, Karnataka, the best orthopaedic hospital in Bangalore, offer comprehensive limb correction and lengthening medical services for both adults and children. We offer treatment options to individuals who may not have had access to other treatment options. From initial consultation to post-treatment recovery and rehabilitation, we strive to provide comprehensive education, tailored recommendations and exceptional care.