Orthopedic surgery and rehabilitation for the prolongation of brace-free ambulation of patients with Duchenne muscular dystrophy.

The purpose of this study was to prospectively evaluate the results of a short comprehensive program involving early lower extremity musculotendinous surgery followed by a definitive course of rehabilitation on contractures and the duration of ambulation for patients with Duchenne muscular dystrophy. Seven patients were treated while ambulating with little difficulty and six were treated just before or after becoming wheelchair-dependent. Predicted post-treatment duration of ambulation was calculated from established clinical criteria. Actual prolongation of brace-free ambulation after treatment was a mean of 0.8 yr greater than predicted for the group as a whole but 0.93 yr for the group treated early by comparison with 0.63 yr for those treated according to the customary approach. The number of falls significantly decreased from 84 +/- 87 to 1 +/- 1 per month postoperatively (P less than 0.05); however, the speed of ambulation over a distance of 10 yards decreased from 10.2 +/- 4 s to 12.1 +/- 7.3 s. Three patients who had tibialis posterior transfers retained antigravity plus dorsiflexor strength and continue to wear normal footwear 2.5, 3.7 and 4.0 yr after loss of ambulation. We conclude that ambulation becomes more stable and brace-free ambulation may be prolonged by a comprehensive program of early orthopedic surgery and rehabilitation. Earlier intervention is also better tolerated.