In the weeks before surgery, your child
will commence physiotherapy. This will consist of a training
programme to stretch and strengthen particular muscles. Fitness is
also important and activities such as swimming and bike riding are
recommended.
The external fixater may be in place
for many weeks. During this time it is important that range of
movement and strength are maintained.
Early weightbearing (as advised by the
orthopaedic surgeon) is generally prescribed -weightbearing is
helpful for the proper formation of new bone as well as forthe
maintenance of bone density.
In reconstructive surgery, when bone is
re-aligned or lengthened, muscles are placed under tension. During
the lengthening process, muscles resist elongation more than any
other structure. The muscles must therefore be stretched as part of
a regular routine of exercise. Stretching and exercise are
essential from the early post operative days until the completion
of treatment. Children whose muscles are supple generally cope more
easily during the post-operative period, so physiotherapy in the
weeks before surgery will be very helpful. In limb reconstructions
below the knee, the muscles which require stretching are the calf
muscle, (the bulky muscle at the back of the lower leg), the
hamstrings (the muscle at the back of the thigh which bends the
knee) and the toe flexors (the muscle which curls the toes).
The calf muscle attaches above to the
lower end of the thighbone, and below it attaches to the heel bone.
The normal healthy calf muscle is sufficiently long and supple to
allow the knee to remain fully straight while the foot is lifted up
towards the face. When the knee is straight and the foot is pulled
up as far as possible towards the face, the calf muscle is
stretched and under relative tension. (figure 1).
Figure 1
When the knee is bent and the foot is
dropped down, the calf muscle is shorter and under less tension.
(figure 2)
Figure 2
After surgery
Application of an external fixator to
lengthen bone or correct deformity places muscles under tension. A
centimetre or 2 of lengthening of bone must be accompanied by
similar lengthening of muscle; otherwise the relative shortening of
muscle compared with bone will result in muscle tightness after
surgery. When the calf muscle is tight, the foot will be pulled
downwards and the knee will be difficult to straighten. When the
toe flexors are tight, the toes will curl downwards. (figure 3)
Figure 3
After surgery, appropriate exercise and
correct positioning will maintain the necessary length of muscles.
Before surgery some simple exercises to stretch and strengthen will
be most beneficial.