Der posttraumatische „Psychogene Klumpfuß”

Summary

Two cases of posttraumatic “psychogenic clubfoot” deformity are reported.

Case I. A woman, aged 44, with foot deformity after infantile paralysis on the right side sustained an inversion injury to the left ankle in April 1979. Two weeks later she was admitted to our hospital. She was unable to walk and examination showed a drop foot with supination contracture of the left foot. Neurological examination was normal inclusive electromyogram. Ligaments of the ankle and peroneal tendons were reviewed by operative procedure under suspicion of rupture. There were no pathological findings, no hematomas or other traumatic signs. The neurological control examination was normal and psychogenic contracture was diagnosed. The personal history showed a corresponding problematical psychic background.

Case II. A man, aged 24, was admitted to our hospital 3 months after an inversion injury to the right ankle. Examination showed a drop foot with supination contracture (Fig. 1a, b). He walked with two crutches. Roentgenograms were normal, the ankle had normal stability, and neurological examination showed no pathological findings. There were no signs of an organic lesion. Psychogenic club-foot was diagnosed.

Both patients were treated functionally with active exercises and psychological care. The follow-up control 1 resp. 1/2 year after injury showed normal muscles and free active mobility in both cases (Fig. 1c, d).

Zusammenfassung

Anhand zweier Patienten mit psychogenem Klumpfuß wird über these seltene Form einer posttraumatischen Kontraktur berichtet. Die Diagnose „psychogene Kontraktur” kann selbstverständlich nur nach gewissenhaftem Ausschluß eines organischen Leidens gestellt werden. Besonders sorgfältig müssen Erkrankungen des zentralen und peripheren Nerven-systemes ausgeschlossen werden.

Die Therapie besteht neben einer entsprechenden psychischen Betreuung in einer krankengymnastischen Übungsbehandlung im Sinne einer Verhaltenstherapie. Mit dieser Therapie konnte in einem Fall eine vollständige, im anderen Fall eine nahezu vollständige Remission der Symptome erzielt werden.