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This article is part of the supplement: Proceedings of the Australasian Podiatry Council Conference 2011

Open Access Oral presentation

Calf cramp in children with Charcot-Marie-Tooth disease: searching for therapeutic targets

Fiona Hawke12*, Monique Ryan3, Robert Ouvrier14 and Joshua Burns14

Author Affiliations

1 Discipline of Paediatrics and Child Health, The University of Sydney, Westmead, NSW, 2145, Australia

2 Podiatry Program, The University of Newcastle, Ourimbah, 2258, Australia

3 Neurosciences Department, Royal Children’s Hospital, Parkville, 3052, Victoria

4 Institute for Neuroscience and Muscle Research, The Children’s Hospital at Westmead, Sydney, NSW, 2145, Australia

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Journal of Foot and Ankle Research 2011, 4(Suppl 1):O18  doi:10.1186/1757-1146-4-S1-O18

The electronic version of this article is the complete one and can be found online at: http://www.jfootankleres.com/content/4/S1/O18


Published:20 May 2011

© 2011 Hawke et al; licensee BioMed Central Ltd.

This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background

Leg muscle cramps have been identified as the strongest independent predictor of worse quality of life in Australian children with Charcot-Marie-Tooth disease Type 1A (CMT1A). There is no accepted treatment for cramp in children with CMT and the cause of cramp is not well understood. Potential therapeutic targets should be carefully identified to direct clinical trials of interventions.

Methods

81 children aged 2-16 years with CMT1A were recruited nationally through the Australasian Paediatric Charcot-Marie-Tooth Disease Registry. Body size and measures of strength, ankle range, foot posture, balance, agility, endurance, gait and neurophysiology were assessed at The Children's Hospital at Westmead (Sydney) and Royal Children's Hospital (Melbourne). Data analysis included Pearson product moment and Spearman rank correlation coefficients for normally and non-normally distributed continuous data respectively, and Fischer's exact test for dichotomous data.

Results

Of the 81 children, 26 reported calf cramp and 1 child each reported toe, quadriceps or arm cramp. Calf cramp was associated (p < 0.05) with older age; stronger foot inversion, eversion, dorsiflexion and plantarflexion measured with a hand held dynamometer; and better performance in long jump. When adjusted for age, foot strength and long jump performance were not associated with cramp. Interestingly, stronger fist grip and worse performance on the 9-hole peg test (a measure of fine motor coordination) were associated with calf cramp and remained associated when accounting for age. Children who experienced calf cramp were also more likely to experience hand tremors (42% vs 16%; p=0.004). Calf cramp was not associated with body mass index, ankle dorsiflexion range, foot posture, balance, agility, gait parameters or nerve conduction velocity. Results of logistic regression modelling will be presented at the conference.

Conclusions

No physical or neurophysiological lower limb measure was associated with calf cramp when accounting for age. The association between increased age and cramp may be due to disease severity and/or progression. This hypothesis is supported by the association of calf cramp with hand tremors and worse fine motor coordination, yet does not explain increased grip strength. Paradoxically, calf cramp is not associated with any lower limb measure of disease severity/progression.