Poliomyelitis



- See:
       - Equinovalgus
       - Anterior Horn Cell Disorders:
       - outside links:
               - Polio Resources:
               - Lincolnshire Polio Network

- Discussion:
    - caused by death of
anterior horn cells of spinal cord or brain stem by an acute viral (polio) infection;
    - diff dx:
          - spinal cord tumor
          - Guillain Barre Syndrome:
                - this syndrome can be distinguished from polio using CSF examination;
                - in Guillain Barre, CSF is notable for increased protein levels and relatively normal cell count;
                - in polio CSF shows upto 300 nucleated cells (PMNS early, lymphocytes late) w/ relatively normal protein levels;


- Clinical findings:
    - there is fever, stiffness of the neck (nuchal rigidity), and a plecocytosis in cerebrospinal fluid;
    - profound asymmetrical muscle weakness develops;
    - initial phase is typically followed by some recovery of muscle strength, but permanent weakness results from necrosis of anterior horn cells;
    - foot and ankle:
           - calcaneocavus (hindfoot cavus) which occurs as a result of a weak gastrocnemius;
           - foot intrinsics are typically spared in polio;
           - claw toes: results from relative overactivity of the long toe flexors and extensors (to compensate for weakness of the triceps);


- Post-polio Syndrome:
    - years following a polio infection,  pts develop slowly progressive muscle weakness in the already involved muscles;
    - common finding is weakness of the quadriceps and calf muscles;
          - when occurring individually, the quadriceps can help compensate for for a weak calf;
          - w/ triceps weakness, the ability to decelerate the tibia is lost and therefore, flexion of the knee will persist throughout stance phase; (see: gait)
          - in order to prevent this, the patient may attempt to compensate with increased quadriceps activity during a larger portion of stance phase;
          - in the case of a weak quadriceps and triceps, the occurance of an equinus contracture or a hinged AFO w/ dorsiflexion block will both prevent excessive
                  knee flexion and excessive ankle dorsiflexion during stance phase;
                  - avoid the pitfall of lengthening of the Achilles tendon in these patients;
                  - these patients may require an ischial bearing, double upright locked knee orthosis, which helps prevent the knee from buckling during gait



The postpolio syndrome. An overuse phenomenon.

Findings in post-poliomyelitis syndrome. Weakness of muscles of the calf as a source of late pain and fatigue of muscles of the thigh after poliomyelitis.

Orthotic Management of the Late Postpolio Patient. Pritham C, et al. Orthot Prosthet. 1979;33(1):55-59

Calcaneal osteotomy and tendon sling for the management of calcaneus deformity.

Posterior Tibial Tendon Transfer: Results of Fixation to the Dorsiflexors Proximal to the Ankle Joint



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, May 29, 2012 4:49 pm