Functional dystonia in the foot and ankle

Author:

Gray Julia1,Welck Matthew1,Cullen Nicholas P.1,Singh Dishan1

Affiliation:

1. Foot and Ankle Unit, The Royal National Orthopaedic Hospital, London, UK

Abstract

Aims To assess the characteristic clinical features, management, and outcome of patients who present to orthopaedic surgeons with functional dystonia affecting the foot and ankle. Methods We carried out a retrospective search of our records from 2000 to 2019 of patients seen in our adult tertiary referral foot and ankle unit with a diagnosis of functional dystonia. Results A total of 29 patients were seen. A majority were female (n = 25) and the mean age of onset of symptoms was 35.3 years (13 to 71). The mean delay between onset and diagnosis was 7.1 years (0.5 to 25.0). Onset was acute in 25 patients and insidious in four. Of the 29 patients, 26 had a fixed dystonia and three had a spasmodic dystonia. Pain was a major symptom in all patients, with a coexisting diagnosis of chronic regional pain syndrome (CRPS) made in nine patients. Of 20 patients treated with Botox, only one had a good response. None of the 12 patients who underwent a surgical intervention at our unit or elsewhere reported a subjective overall improvement. After a mean follow-up of 3.2 years (1 to 12), four patients had improved, 17 had remained the same, and eight reported a deterioration in their condition. Conclusion Patients with functional dystonia typically presented with a rapid onset of fixed deformity after a minor injury/event and pain out of proportion to the deformity. Referral to a neurologist to rule out neurological pathology is advocated, and further management should be carried out in a movement disorder clinic. Response to treatment (including Botulinum toxin (Botox) injections) is generally poor. Surgery in this group of patients is not recommended and may worsen the condition. The overall prognosis remains poor. Cite this article: Bone Joint J 2021;103-B(6):1127–1132.

Publisher

British Editorial Society of Bone & Joint Surgery

Subject

Orthopedics and Sports Medicine,Surgery

Cited by 5 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Rehabilitation for Functional Dystonia: Cases and Review of the Literature;Movement Disorders Clinical Practice;2024-06-09

2. Pain and functional neurological disorder: a systematic review and meta-analysis;Journal of Neurology, Neurosurgery & Psychiatry;2024-02-21

3. Modern principles of diagnosis and treatment in complex regional pain syndrome;Deutsches Ärzteblatt international;2022-12-27

4. Functional dystonia: A pitfall for the foot and ankle surgeon;Foot and Ankle Surgery;2021-10

5. Foot & Ankle;Bone & Joint 360;2021-10

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