Functional dystonia: A pitfall for the foot and ankle surgeon |
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Institution: | 1. Department of Physical Medicine and Rehabilitation, Liege University Hospital Center, University of Liège, Liège, Belgium;2. Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium;3. UCLouvain, Faculty of Motor Sciences at Université Catholique de Louvain-La-Neuve, Louvain, Belgium;4. HEL (Haute Ecole de la ville de Liège), Liège, Belgium;5. Department of Physical Medicine and Sports Traumatology, SportS(2), FIFA Medical Centre of Excellence, University and University Hospital of Liège, Liège, Belgium;1. Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zalo?ka cesta 9, 1000 Ljubljana, Slovenia;2. Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Kongresni trg 12, 1000 Ljubljana, Slovenia;3. Sanatorij MD Medicina, Bohori?eva ulica 5, 1000 Ljubljana, Slovenia;1. Hospital for Special Surgery, New York, NY, United States;2. University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, United States;3. Orthopaedic Specialists – UPMC, Pittsburgh, PA, United States;1. Complejo Asistencial Doctor Sótero del Río, C.A.S.R., Chile;2. Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Chile;3. Foot and Ankle Unit, Department of Orthopedic Surgery, Hospital del Trabajador, Santiago, Chile;4. Foot and Ankle Unit, Department of Orthopedic Surgery, Clinica Las Condes, Chile |
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Abstract: | Functional dystonia represents a condition where psychological distress is being expressed as involuntary muscle contractions. In the foot and ankle, it most commonly presents as a sudden onset of a painful fixed ankle/hindfoot deformity in a female patient with a history of trivial trauma or surgery. The “fixed deformity” found on clinical examination is usually correctable under general anesthesia. Less commonly, it can present in the toes or may present as paroxysmal muscle movements rather than a fixed deformity. CRPS may occur concurrently with the dystonia.Failure to consider the diagnosis leads to a long delay in appropriate diagnosis, patient distress and unnecessary or even harmful surgery. A better approach to this clinical syndrome is to define it as fixed abnormal posturing that is most commonly psychogenic. Early referral to a movement disorder clinic is recommended. The prognosis is generally poor as less than a quarter of patients report subjective long-term improvement even when managed in a movement disorder clinic. Foot and ankle surgeons should, whenever possible, avoid operating on patients with functional dystonia in order to avoid symptomatic deterioration. |
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Keywords: | Functional dystonia Hysteric contracture Psychogenic contracture Hysteric clubfoot Post-Traumatic dystonia |
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