Hesperian Health Guides

Evaluating Which Deformities Should Be Corrected and Which Should Not

In this chapter:

PART 3 of this book, in addition to aids and equipment, also discusses methods for correcting joint contractures, which are discussed in Chapter 59. Just as you need to decide if a brace is appropriate, you need to decide whether correcting a contracture will actually help a child. Although many contractures increase difficulty for a child, some may actually help and should be left uncorrected. For example:

Child with polio with tiptoe contracture on weak leg but straight spine.
In a child with polio, the weaker leg is often shorter.
The foot hangs down and often develops a tiptoe contracture which, in effect, makes the leg longer.
Child with polio with flat foot on weak leg that is shorter, and curved spine.
If we correct the foot contracture, the leg will, in effect, become “shorter.” This can cause tilting of the hips, a spinal curve, and more awkward walking.
contracture corrected
Child with polio with high shoe and brace on weak leg, with straight spine.
To correct the hip tilt and spinal curve, the child will need a lift on the shoe, and probably a brace too.
This usually makes walking more difficult, and the disability more noticeable, than before the contracture was corrected.
For this child it may be best NOT to correct the contracture.

Other examples of contractures that are sometimes more beneficial than harmful are finger contractures in persons with hand paralysis and tightness of back muscles in persons with spinal cord injury or muscular dystrophy.

Curved foot due to contracture.
In children with spastic cerebral palsy, sometimes orthopedic surgeons perform operations to correct contractures or awkward positions, without completely evaluating the effects on the children. Often children find it harder to walk or function after the surgery. Always seek the opinion of therapists and other orthopedists before deciding to have the operation.

Before deciding to correct any contractures or deformities, try to be sure that the correction will help the child to do things better.

This page was updated:05 May 2022