Home > Journals > European Journal of Physical and Rehabilitation Medicine > Past Issues > European Journal of Physical and Rehabilitation Medicine 2022 August;58(4) > European Journal of Physical and Rehabilitation Medicine 2022 August;58(4):575-83

CURRENT ISSUE
 

JOURNAL TOOLS

Publishing options
eTOC
To subscribe
Submit an article
Recommend to your librarian
 

ARTICLE TOOLS

Publication history
Reprints
Permissions
Cite this article as
Share

 

ORIGINAL ARTICLE   Free accessfree

European Journal of Physical and Rehabilitation Medicine 2022 August;58(4):575-83

DOI: 10.23736/S1973-9087.22.07355-5

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Validation of a semiological maneuver for the evaluation of spastic dynamic clubfoot: an approach based on the judgment of experts in physical medicine and rehabilitation

Javier BENAVIDES , Oscar E. CASTRO

Department of Physical Medicine and Rehabilitation, University of Valle, Cali, Colombia



BACKGROUND: The evaluation of spasticity of the plantar flexors in dynamic clubfoot is difficult due to the almost invariable concomitance of Achilles clonus, which is a semiological artifact. No description was found in the literature of a technique for inhibiting or reducing the discharge generated by Achilles clonus to allow a correct assessment of spasticity in this segment.
AIM: Validation of a semiological maneuver that reduces or eliminates Achilles clonus for the adequate evaluation of spastic dynamic clubfoot.
DESIGN: Multicenter cross-sectional study.
SETTING: The study was conducted by 12 experts in physical medicine and rehabilitation from various clinics and hospitals in Colombia.
POPULATION: Thirty-five adults with dynamic spastic clubfoot and Achilles clonus secondary to upper motor neuron syndrome who attended outpatient consultation at physical medicine and rehabilitation services in eight cities Colombia from August 2020 to February 2021.
METHODS: The usual method for examining spastic plantar flexors was compared to the proposed semiological maneuver to evaluate the proposed maneuver contributed to the reduction or elimination of Achilles clonus to allow a more accurate measure of spasticity in this segment. Four dimensions were evaluated by the experts: time required for application, simplicity, effectiveness and clinical utility. A cutoff point was established to identify whether the maneuver was unacceptable, acceptable or excellent.
RESULTS: The application of the maneuver was able to reduce or eliminate Achilles clonus as a masking sign of spasticity in the plantar flexors in 100% of the patients and was considered excellent in 77.1% of the cases for the four dimensions evaluated. A decrease in the degree of spasticity of the plantar flexors was observed when the maneuver was applied.
CONCLUSIONS: The proposed maneuver reduces or eliminates Achilles clonus, which could allow a more precise evaluation of spasticity in this segment. All of the experts recommended including the maneuver in routine examinations of this population.
CLINICAL REHABILITATION IMPACT: Applying the proposed maneuver could improve the selection of patients with spastic dynamic clubfoot who require specific treatment.


KEY WORDS: Clubfoot; Muscle spasticity; Achilles tendon; Muscle contraction

top of page