As a child with DMD gets older, his muscle weakening progresses. The weakness in DMD is generally considered symmetrical, meaning that both sides of the body get weaker at approximately equal rates. However, the muscles on each side of a particular joint don't necessarily get weak at the same rate. The stronger muscles pull the joint in their direction and, along with gravity and the usual position of the body (i.e. sitting), joints become fixed in a certain position over time. These fixations of the joints are known as contractures.
In DMD, the knees and hips usually become flexed in the sitting position. The feet usually end up pointing inward and downward. Elbows may also end up flexed. Hands may point downward because of wrist contractures, and fingers may stay flexed because of contractures in the finger joints.
Contractures can be a devastating complication of DMD, and muscular dystrophy in general, because they interfere with normal functioning of the affected body part. They can usually be postponed or slowed down, if not entirely prevented.
Sometimes, surgery is done to relieve contractures. One type of surgery, called a tendon release, is often done to treat ankle and other contractures while the child is still walking (around age 8 to 10). As the front calf muscle weakens, the stronger rear calf muscle pulls the heel upward, causing the toes to point downward. Surgery to cut the Achilles tendon prevents permanent contracture. This allows the foot to resume a natural position. After the surgery, the child is usually put into a cast and then into leg braces to keep the contracture from immediately reforming.
With the braces, a child with DMD may be able to walk for a while longer than he would have otherwise.
Some doctors do not recommend this type of surgery because they believe it may do more harm than good to subject a child to this kind of stress and pain. The surgery will also cause a child to be off his feet which, even for a short time during the recovery period, can lead to additional muscle weakening.
It's essential that after surgery the child stand and walk the very day of their tendon release surgery. That way, they avoid the complications associated with immobility and gain the benefit of the surgery.
Talking to doctors and to people who have or have not had surgery for contractures is a good idea. Factors to consider include how well a child tolerates discomfort, how motivated he is to wear braces to continue walking and how much time he's likely to continue walking after the surgery. If he's old enough, the child should be involved in the decision.
