Management Of Spastic Equinovarus Foot in Children with Cerebral Palsy: An Evaluation of Anatomical Landmarks for Selective Nerve Blocks of the Tibial Nerve Motor Branches.
Alessandro Picelli, Rita Di Censo, Alessandro Zadra and 3 others
PMID 36807992WHAT IT FOUND
Ultrasound landmarks for tibial motor branches to calf muscles were mapped in 24 children with cerebral palsy and spastic equinovarus foot.
Positions were given as percentages of leg length, not only millimetres, to help target diagnostic nerve blocks.
Key findings
01In 24 children with cerebral palsy and spastic equinovarus foot, ultrasound mapped tibial motor branches to the gastrocnemii, soleus and tibialis posterior muscles.
02Branch positions were described as percentages of affected leg length and as millimetre distances.
03The paper reported no significant correlation between the landmarks and other ultrasound or clinical features, except an association between ankle dorsiflexion passive range and the gastrocnemius lateralis vertical coordinate (p = 0.524).
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Only 24 children were studied at one centre, so the landmarks may not apply to all children with cerebral palsy. There were no healthy control children, so the study cannot show whether spastic cerebral palsy changes nerve branch position. It did not evaluate motor branches to flexor digitorum longus or flexor hallucis longus, which may also be blocked. It did not report outcomes after nerve blocks, so it does not show that these landmarks improve patient care. The reported association between ankle dorsiflexion range and one branch coordinate had p = 0.524, which is not a significant finding.
The easy way to misread this
Do not read this as evidence that nerve blocks improve spasticity, walking or function in children with cerebral palsy. It was a small observational ultrasound mapping study without a control group and without post-block outcomes.