Interventions for increasing ankle flexibility in people with neuromuscular disease

Loss of ankle flexibility is a common problem for people with neuromuscular disease. It can cause foot deformity, pain and problems walking. The purpose of this review was to assess the evidence regarding the effectiveness of interventions for improving ankle flexibility in people with neuromuscular disease. Four studies were included in the review involving a total of 149 participants. Two studies showed that wearing a night splint was no more effective than not wearing a night splint for increasing ankle flexibility in 26 people who had Charcot-Marie-Tooth disease type 1A. One study showed corticosteroids (prednisone) did not significantly improve ankle flexibility in 103 boys with Duchenne muscular dystrophy and the other study showed that while orthopaedic surgery initially increased ankle flexibility in 20 young boys with Duchenne muscular dystrophy this was not sustained in the long term. This review shows that, currently, there is limited evidence supporting any intervention for improving ankle flexibility in patients with Charcot-Marie-Tooth disease type 1A and Duchenne muscular dystrophy. More research is needed.

Authors' conclusions: 

There is no evidence of significant benefit from any intervention for increasing ankle range of motion in Charcot-Marie-Tooth disease type 1A or Duchenne muscular dystrophy. Further research is required.

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Background: 

Reduced ankle dorsiflexion range of motion, or ankle equinus, is a common and disabling problem for patients with neuromuscular disease. Clinicians devote considerable time and resources implementing interventions to correct this problem although few of these interventions have been subject to rigorous empirical investigation.

Objectives: 

To assess the effect of interventions to reduce or resolve ankle equinus in people with neuromuscular disease.

Search strategy: 

We searched the Cochrane Neuromuscular Disease Group Trials Specialized Register (August 2009), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2009), MEDLINE (1966 to August 2009), EMBASE (1980 to August 2009), CINAHL 1982 to August 2009), AMED (1985 to August 2009) and The Physiotherapy Evidence Database (PEDro) (1929 to August 2009). We searched the reference lists of identified articles and also contacted known experts in the field to identify additional or unpublished data.

Selection criteria: 

Randomised controlled trials evaluating interventions for increasing ankle dorsiflexion range of motion in neuromuscular disease. Outcomes included ankle dorsiflexion range of motion, functional improvement, foot alignment, foot and ankle muscle strength, health-related quality of life, satisfaction with the intervention and adverse events.

Data collection and analysis: 

Two authors independently selected papers, assessed trial quality and extracted data.

Main results: 

Four studies involving 149 participants met inclusion criteria for this review. Two studies assessed the effect of night splinting in a total of 26 children and adults with Charcot-Marie-Tooth disease type 1A. There were no statistically or clinically significant differences between wearing a night splint and not wearing a night splint. One study assessed the efficacy of prednisone treatment in 103 boys with Duchenne muscular dystrophy. While a daily dose of prednisone at 0.75 mg/kg/day resulted in significant improvements in some strength and function parameters compared with placebo, there was no significant difference in ankle range of motion between groups. Increasing the prednisone dose to 1.5 mg/kg/day had no significant effect on ankle range of motion. One study evaluated early surgery in 20 young boys with Duchenne muscular dystrophy. Surgery resulted in increased ankle dorsiflexion range at 12 months but functional outcomes favoured the control group. By 24 months, many boys in the surgical group experienced a relapse of achilles tendon contractures.

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