Treatment of severe equinovarus deformity associated with distal myopathy

Abstract

Inclusion body myopathy (IBM) is a form of distal myopathy which is characterized by progressive muscle weakness and wasting.1 A healthy 23-year-old male with unremarkable past medical history presented with left ankle pain and contracture of approximately one year duration. Physical exam findings revealed a markedly rigid ankle contracture as well as left calf atrophy. After a multi-specialty workup, the decision was made for the patient to undergo an open z-plasty of the left achilles tendon in conjunction with surgical biopsy of the left soleus muscle belly. The pathology report showed “myopathy with rimmed vacuoles and chronic inflammation suggestive of inclusion body myopathy”. In the nearly three years since surgery, patient has achieved a plantigrade foot without ankle equinus. He ambulates without pain and without an assistive device in standard shoe gear. Inclusion Body Myopathy is a progressive disorder which ultimately has no cure. While genetic testing and imaging modalities can be useful, the gold standard for most forms of distal myopathy requires a muscle biopsy. Treatment should be geared towards alleviating associated symptoms. While rare, distal myopathies in all their forms should be included among a podiatric surgeon's differential diagnoses when signs of muscle imbalance are present, such as equinus contracture, anterior compartment weakness, and gastrocnemius atrophy. Open surgical correction can help alleviate pain and symptoms associated with distal myopathy. Level of clinical evidence: Level 4, case-control study

Keywords

• Equinus
• Muscle biopsy
• Rigid
• Tendo achilles lengthening