Category: Clinical Sciences/Health Conditions
Case Diagnosis: Elective amputation for an equinovarus deformity in a patient with Multiple Sclerosis.
A 58-year-old female with a history of progressive Multiple Sclerosis, dependent on a wheelchair for mobility, presented to clinic with mild hip and knee flexion contractures and an equinovarus foot deformity, limiting her ability to stand and transfer, as well as putting her at increased risk for a pressure ulcers. The equinovarus deformity was initially thought to be due to her spasticity. Further work up revealed a history of a total hip arthroplasty 8 years earlier. An EMG confirmed a chronic severe peroneal nerve injury as a secondary contributing factor. She received botulinum toxin injections, physical therapy, and splinting, with minimal change in the foot’s position. She was not a surgical candidate for correction due to peripheral vascular disease. As a final option, she underwent an elective below the knee amputation. She continues to work with physical therapy toward transfers, standing, and ambulation.
Prior to amputation, the patient’s strength and range of motion were thought to be compatible with standing and walking; however, the equinovarus deformity limited that ability. With continued physical therapy, she is on target to achieve her goals. Amputations carry risks including infection, slow wound healing, phantom limb pain, falls, and rejection of a prosthesis. These risks must be weighed with the potential benefits. In this patient’s case, undergoing an elective amputation helped her improve her ability to stand, transfer, and ambulate in her home.
While uncommon, an elective amputation can be considered to restore function and mobility in patients with a severe equinovarus deformity. While neurological and musculoskeletal co-morbidities may complicate function, with realistic goals, proper adjustment of the prosthesis, and physical therapy, a patient may benefit from an elective amputation.