# Poliomyelitis Orthopaedic Sequelae > Poliomyelitis orthopaedic sequelae for NEET-PG Orthopaedics: paralytic deformities, post-polio syndrome, tendon transfers and arthrodesis in India. - Canonical URL: https://prepelephant.com/topics/neet-pg/orthopaedics/poliomyelitis-orthopaedic-sequelae - Exam / course: NEET-PG · Subject: Orthopaedics - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-14 - Last updated: 2026-10-14 - Reference basis: Maheshwari's Essential Orthopaedics; Apley's System of Orthopaedics and Fractures - How to cite: "Poliomyelitis Orthopaedic Sequelae", PrepElephant, https://prepelephant.com/topics/neet-pg/orthopaedics/poliomyelitis-orthopaedic-sequelae ## Direct answer Poliomyelitis sequelae are the permanent paralytic deformities left after poliovirus destroys anterior horn cells in the spinal cord. The affected limb shows flaccid weakness and muscle imbalance, producing equinovarus, knee instability, hip subluxation or scoliosis depending on which muscles are spared. Management stabilises the joints first, then uses tendon transfers or arthrodesis once the paralysis has stopped changing. ## What you must remember - **Cause:** poliovirus destroys lower motor neurons in the anterior horn, leaving flaccid paralysis of the muscles they supply. - **Foot deformity:** equinovarus results from unopposed posterior tibial and calf action, while calcaneovalgus appears when the triceps surae is paralysed. - **Knee:** quadriceps weakness produces instability or recurvatum, managed with a brace or, rarely, arthrodesis. - **Hip:** abductor weakness gives a Trendelenburg gait, and imbalance of the hip muscles can lead to subluxation or dislocation. - **Post-polio syndrome:** new weakness, fatigue and pain appearing years after recovery, believed to reflect loss of motor units; it is not a recurrence of the virus. - **Tendon transfer:** one spared muscle is moved to take over the function of a paralysed one, usually performed about a year after the acute illness. - **Arthrodesis:** fusion of an unstable joint, such as the ankle or subtalar joint, when muscle power is too weak for transfer. - **Indian context:** India was certified polio-free by WHO in 2014, yet residual deformities remain in older patients. ## From a residual foot drop to a stable, functional foot A 16-year-old with a residual foot drop and an equinovarus foot after childhood polio has a stable knee but weak anterior tibial muscles. The reasoning runs from assessment to correction, and only then to transfer or fusion. 1. **Assess the muscle balance:** test each muscle group to identify which are paralysed, which are spared and whether the joint is passively correctable. 2. **Correct the fixed deformity first:** soft-tissue release or a lateral closing-wedge calcaneal osteotomy corrects the hindfoot before any transfer is considered. 3. **Wait for stability:** tendon transfers are timed after the paralysis has settled, typically around a year after the acute illness, because earlier surgery risks poor results as strength changes. 4. **Transfer a donor tendon:** a spared tendon, commonly the posterior tibial or peroneal, is moved to the dorsum of the foot to restore active dorsiflexion. 5. **Stabilise when power is inadequate:** ankle or subtalar arthrodesis fixes a flail joint, so that the limb can bear weight in a brace. 6. **Brace and rehabilitate:** an ankle-foot orthosis with progressive gait training protects the joints and preserves function after surgery. ## Where the exam tries to catch you Examiners test the timing of surgery and the difference between post-polio syndrome and infection. - **Trap:** performing a tendon transfer on a muscle still in recovery. **Correct:** transfers are delayed until the paralysis stabilises, since surgery during change risks losing the benefit. - **Trap:** assuming post-polio syndrome means relapse of the infection. **Correct:** it is a late, new weakness in previously recovered muscles, with no active viral infection. - **Trap:** choosing arthrodesis for every unstable joint. **Correct:** fusion suits joints where muscle power is insufficient, whereas transfers aim to restore motion where a donor tendon is available. ## Frequently asked questions ### What is post-polio syndrome? Post-polio syndrome is new muscle weakness, fatigue and pain that appear years after recovery from paralytic poliomyelitis. It is not a recurrence of the virus, and it is managed with energy conservation, bracing and rehabilitation. ### Which foot deformity is typical after poliomyelitis? Equinovarus is a classic foot deformity after polio, caused by unopposed plantarflexion and inversion from preserved calf and posterior tibial muscles. Calcaneovalgus is the opposite pattern, seen when the calf muscles are paralysed. ### When are tendon transfers performed after poliomyelitis? Tendon transfers are performed once the paralysis has stabilised, usually about a year after the acute illness, and when the joint can be passively corrected. Earlier surgery risks poor results as strength continues to change. ### What is the role of arthrodesis in poliomyelitis sequelae? Arthrodesis fuses an unstable joint, most often the ankle or subtalar joint, so that a weak limb can bear weight. It is chosen when muscle power is too weak for tendon transfer or when the joint is flail. ### Why does polio still matter in orthopaedic training in India? Residual deformities persist in many adults who were affected before vaccination coverage became widespread, even though India was certified polio-free by WHO in 2014. Management of established deformity therefore remains part of practice.