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Rehabilitation Practice and Science

Translated Title

應用超音波導引注射類固醇及肉毒桿菌素治療外傷性蹠骨截肢合併馬蹄足內翻變形之病歷報告

Abstract

In this report we share 21 year-old young man with traumatic transmetatarsal amputation treated with multiple operations after few weeks of surgery. Foot equinovarus deformity was noted which leads to walking disability and affects daily activities. Patient was referred to us from orthopedic doctor because he hesitated to have another operation for Achilles tendon lengthening. During the physical examination, equinovarus foot with hip contracture were observed which may be caused by muscle imbalance or nerve injury. Nerve conduction velocity and electromyography tests (NCV/EMG) was arranged for differentiating between neurogenic contraction and myogenic contracture. Peroneal nerve injury was ruled outafter the NCV/EMG examination, sonography was used to check for the presence of muscle lesions. Hip joint tapping with echo-guided local injection of steroids was performed for hip flexion contracture. Hip joint flexion contracture was improved from 15 degree to 0degree. And the left ankle ultrasound examination revealed effusion over anterior recesses, thickening of retrocalcaneal bursa and hypoechoic changes over tibialis posterior tendon. Afterecho-guided ankle joint tapping with steroid injection, ankle plantar contracture was improved from 30 degree to 20 degree. And then we calculated the required dose of botulinum toxin A (BTA) and injected it into the left gastrocnemius lateral/medial head, soleus, tibialis posterior muscle, flexor digitorum brevis muscleusing sonographic guidance. An ankle could return to its neutral position. After 3 weeks of ambulation training with supra malleolar orthosis he could walk independently. In summary, combined use of echo-guided injection of steroid and BTA, ankle contracture can be restored.

Language

Traditional Chinese

First Page

53

Last Page

58

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