Évaluation de deux traitements orthopédiques (plâtres d'allongement et orthèses dynamiques) dans la correction de l'équin de la cheville chez l'enfant IMC. Étude de dix cas

In our experience, treatment of equinus of the ankle associated with cerebral palsy often uses an articulated AFO with an elastic retaining strap allowing the foot to be dorsiflexed. Since November 2005, we have been fitting an Ultraflex™ dynamic component (Ultraflex Systems Inc., 237 South Street, Suite 200, Pottstown, PA 19464, USA, and UlltraflexEurope by Dirame Ortho, 1740 Ternat, Belgium) providing constant and adjustable tension on AFO orthoses. Ten children with cerebral palsy who were only receiving conservative (nonmedicinal) treatment (physiotherapy and orthosis) were recruited in this observational study. As the main outcome criteria, we used goniometric measurements at consultations to measure the gain or loss of motion at the ankle depending on the type of device, and on the other hand, we estimated the number of serial casts needed to maintain the gain in dorsiflexion despite the child's growth. As secondary outcome criteria, we scored compliance with the treatment (extended use of the orthosis, quality of sleep, skin tolerance, ease of fitting the device). Results: main benefits. When applying dorsiflexion on the ankle without using a dynamic system, we observed a loss of motion over the period of observation. When measuring the degrees of dorsiflexion with a dynamic AFO, we observed a gain of motion over the period of observation. The number of serial casts is reduced when orthoses are worn that provide constant and adjustable dynamic tension. Secondary benefits: the average score obtained for each compliance criterion is improved when using dynamic orthoses.