Sensory hypoinnervation in club foot

Abstract

We have compared the density of nerve fibres in the synovium in club foot with that of specimens obtained from the synovium of the hip at operations for developmental dysplasia. The study focused on the sensory neuropeptides substance P; calcitonin gene-related peptide; protein gene product 9.5, a general marker for mature peripheral nerve fibres; and growth associated protein 43, a neuronal marker for new or regenerating nerve fibres. In order to establish whether there might be any inherent difference we analysed the density of calcitonin gene-related peptide-positive nerve fibres in the hip and ankle joints in young rats. Semi-quantitative analysis showed a significant reduction in the number of sensory and mature nerve fibres in the synovium in club foot compared with the control hips. Calcitonin gene-related peptide (CGRP) positive fibres were reduced by 28%, substance P-positive fibres by 36% and protein gene product 9.5-positive fibres by 52% in club foot. The growth associated protein 43-positive fibres also seemed to be less in six samples of club foot. No difference in the density of CGRP-positive nerve fibres was observed in the synovium between ankle and hip joints in rats. The lack of sensory input may be responsible for the fibrosis and soft-tissue contractures associated with idiopathic club foot.

Doğuştan çarpık ayak etiyolojisi

“…[8] PEV hastalarının sinoviyal sıvısında sinir liflerinin azalmış dansitesi, duyusal uyaranların yokluğu/eksikliği, PEV'le ilişkili fibrozis ve kontraktürlerden sorumlu tutulabilir. [9] Ancak, tam tersine, Tip 1 liflerde indikatif özellik bulunamadığı ve PEV etiyolojisinde nöromus-küler anormalliklerin sorumlu olduğu teorisini desteklemeyen yayınlar da mevcuttur. [10] Tek taraflı PEV hastalarında, etkilenen ekstremite (baldır) çevresi etkilenmeyen tarafa göre daha küçük olup, çeşitli kaslarda kantitatif farklılıklara neden olmaktadır.…”

Der kongenitale Klumpfuß

“…Theorien zur Entstehung einer Klumpfußdeformität durch sensorische Hypoinnervation werden durch immunhistochemische und elektrophysiologische Tests gestützt. Ahmed konnte anhand neuronaler Marker eine signifikante Reduktion an sensorischen Nervenfasern in der Synovia von bis zu 52 % von Klumpfüßen nachweisen [21]. Macnicol fand pathologische somatosensorisch evozierte Potenziale (SSEPs) in 46% seines Patientenguts mit Klumpfüßen [22].…”