Treating Lower Extremity Conditions Of Special Olympics Athletes

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Author(s): 
David W. Jenkins, DPM, FAAPSM

   Down syndrome lower extremity findings include short lower extremities, external hip position/abducted gait, metatarsus adductus, brachymetatarsia, patellar instability, genu valgum, hypermobile pes valgus/pes planus, metatarsus primus varus, hallux abducto valgus/varus, clinodactyly, syndactyly and hip dislocation.

   Fragile X syndrome. Like Down syndrome, Fragile X syndrome is characterized by joint laxity. The associated hyperextensible joints frequently result in findings of excessive pronation and pes planus.11

   Fetal alcohol syndrome. Besides intellectual disability, people with this condition may have a number of abnormal clinical findings, many of which are related to joint structure.12 Fetal alcohol syndrome lower extremity findings may include camptodactyly (fixed flexion deformity of the interphalangeal joints of the digit), clinodactyly (medial curvature of the digits, usually the fifth metatarsal), scoliosis and poor coordination/motor skills.

   Prader-Willi syndrome. Similar to Down and Fragile X syndromes, ligamentous laxity and related structural changes occur with Prader-Willi syndrome.13 Prader-Willi syndrome lower extremity findings include hypotonia, short stature, small hands and feet, scoliosis, ligamentous laxity, hip dysplasia, genu varum and pes planus.

   Apert syndrome. Although Apert syndrome (acrocephalosyndactyly) is primarily characterized by faciocraniosynostosis, it also presents with varying degrees of severe syndactylism as well as brachymetatarsia.14-16

   Cerebral palsy. There are varied degrees of intellectual disability with cerebral palsy, depending upon where the injury to the brain occurs. Likewise, structural manifestations are reflective of brain injury locus but in most cases will present as contractures with characteristic gait patterns.17-18

   Hip contractures manifest in the hip (adductors, flexors and internal rotators), knee (flexors) and ankle (plantarflexors). The gait of patients with cerebral palsy can be clumsy or awkward. Patients can have scissors (crossover) gait or walk on the toes. Typically, they have an arm swing to counter the hip adduction.

   Ectrodactyly. Ectodermal clefting syndrome (lobster foot) is quite rare. The foot presents as clefted due to the absence of central rays. There may be associated hallux abducto valgus with metatarsus primus varus and a wide splayed forefoot.19

In Summary

One of the major goals of this article is to educate the clinicians who evaluate and treat foot pathology about the podiatric conditions that occur in the population of athletes with intellectual disabilities.10,20 This enhanced knowledge of podiatric findings that we encounter in people with intellectual disabilities will hopefully result in more effective identification, management and prevention of such disorders, including a referral when appropriate.

   I also hope to encourage clinicians to become involved in screening programs (Fit Feet) in their local communities and/or be a referral resource for those athletes in need of definitive care. The opportunity to encounter and/or manage conditions that many of us have only read about in our training is both educationally and professionally rewarding.

   Dr. Jenkins is a Professor at the Arizona School of Podiatric Medicine at Midwestern University in Glendale, Az. He is a Fellow and Vice President of the American Academy of Podiatric Sports Medicine. Dr. Jenkins is also the Clinical Director for the Special Olympics Arizona Fit Feet Program and a Podiatric Consultant for the Los Angeles Dodgers.

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