Colleagues
This morning I examined a six-month-old girl with extremely restricted
range of motion in right ankle joint – approximately 5-10 degrees. The
foot is held in a neutral mid-stance position. Radiographic examination
reveals no bony abnormality or malformation. Forced extension or flexion
causes obvious distress. Birth was unremarkable except that the baby was in
a breached position until two weeks prior to delivery then she righted
herself. Normal delivery – no forceps or suction. The left ankle ROM is as
one would expect in a six-month-old baby – more than adequate. No adverse
family history. No neurological symptoms. No sensory loss.
My thoughts were that she may have had the ankle extended for a protracted
period – perhaps against the womb wall – during pregnancy and this has
caused contracture of the anterior muscle compartment and associated soft
tissues. Is this feasible given six months have elapsed? Also, is there any
other investigations/treatment that can be offered aside from gradual
manipulation?
Thanks in anticipation.
Mark Russell
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