Lower Limb Deformity in Neuromuscular Disorders: Pathophysiology, Assessment, Goals, and Principles of Management

Deformities of the lower extremity are common in neuromuscular disorders, the acquired consequences of the primary pathology in the brain (e.g., cerebral palsy), the spinal cord (e.g., spina bifida), the peripheral nervous system (e.g., Charcot Marie Tooth syndrome) or the muscle (e.g., muscular dystrophy). The musculoskeletal deformities that arise from these conditions are a result of abnormalities of muscle tone, muscle strength, growth and motor development, motor control, and the impact of these on muscle length, skeletal growth, and remodeling. Although specific deformities might be similar in different neuromuscular conditions, the indications for treatment and the principles of management of these must be considered in the context of the specific disorder, as the impact of specific deformities will vary with the type of disorder (e.g., upper vs. lower motor neuron disorders; static vs. progressive, etc.) as well as the severity of the underlying disorder.