Clinical or radiologic measurements and 3-D gait analysis in children with pes planus

Multivariate functional principal component analysis and k-means clustering to identify kinematic foot types during gait in children with cerebral palsy

BACKGROUND

Children with neuromuscular disorders, such as cerebral palsy, frequently develop foot deformities, such as equinopronovalgus and equinosupovarus, leading to walking difficulties and discomfort. Traditional assessment methods, including clinical measures and radiographs, often fail to capture the dynamic nature of these deformities, resulting in suboptimal treatment. 3D gait analysis using multisegment foot models offers a more detailed understanding of these deformities.

RESEARCH QUESTION

To determine whether the combination of multisegment foot models, multivariate functional principal component analysis, and k-means cluster analyses could identify distinct, clinically relevant foot types in a large pediatric cohort with cerebral palsy.

METHODS

This was a retrospective analysis of 3D gait data from 197 patients with cerebral palsy collected using a multisegment foot model. Multivariate functional principal component analysis was used to reduce these data prior to using k-means clustering to identify foot posture clusters. Further analyses, including ANOVA and Fisher's Exact tests, were used to evaluate demographic, radiographic, and gait characteristics to explain the clinical relevance of each cluster.

RESULTS

Analysis of kinematic data from 371 feet revealed six clinically significant clusters, with a low misclassification rate of 2 %. One-factor ANOVAs demonstrated significant differences across clusters for all MPCs, whereas no significant differences were noted in basic anthropometric variables. Significant variations were observed in radiographic and gait function variables, and a strong association between GMFCS levels and cluster categorization was identified.

SIGNIFICANCE

The novel approach of integrating multivariate functional principal component analysis and k-means clustering identified a spectrum of foot deformities in children with CP, ranging from equinosupovarus to marked equinopronovalgus. This methodology provides an objective classification based on kinematic data and can facilitate improved diagnosis and treatment of cerebral palsy-related foot deformities.

Really Asymptomatic? Health-Related Quality of Life and Objective Clinical Foot Characteristics among 5-10-Year-Old Children with a Flexible FlatFoot

The potential effects of asymptomatic flexible flatfoot (FF) on children's health-related quality of life (QoL) and objective clinical foot characteristics have been poorly investigated in the literature. Therefore, this study aimed to analyse these indicators, comparing the children with asymptomatic FF and a control group.

METHODS

In total, 351 children were enrolled in this cross-sectional study-160 children with asymptomatic FF and 191 controls (children with normal feet). The children and their parents completed the Paediatric Quality of Life Inventory (PedsQL^TM 4.0). The objective foot characteristics included clinical foot posture measures, footprints, general hyperlaxity, and X-ray measurements.

RESULTS

Children with asymptomatic FF had a significantly lower QoL (overall and all four dimensions). The parents' assessment of the QoL of their children with asymptomatic FF in most cases was lower compared to their children's self-reported QoL. Moreover, almost all clinical foot measures also had significantly worse profiles among asymptomatic FF cases compared to the controls. This was observed with the Foot Posture Index-6 (FPI-6), the navicular drop (ND) test, the Chippaux-Smirak Index (CSI), Staheli's Index (SI), the Beighton scale, and radiological angles (except the talo-first metatarsal angle).

CONCLUSION

The findings suggest that asymptomatic FF not always reflects a normal foot development. This condition is related to decreased health-related quality of life, so the 5-10-year-old children's and their parents' complaints should be considered more closely in identification, treatment, and monitoring plans.

Relation of Flatfoot Severity with Flexibility and Isometric Strength of the Foot and Trunk Extensors in Children

BACKGROUND

Flatfoot is a deformity in which the foot is flattened due to a decrease in or loss of the medial longitudinal arch.

STATEMENT OF THE PROBLEM

Few studies have investigated the relationship between the severity of flat feet, trunk strength, and joint flexibility.

PURPOSE

The aim of this study is to investigate the relationship between the severity of flatfoot and joint flexibility and foot and trunk strength in children with flexible flatfoot.

METHODS

This study included 16 children (boys, 12; girls, 4; age, 4~8 years) with flexible flatfeet. We examined the resting calcaneal stance position angle (RCSPA) and foot posture index (FPI) scores for clinical severity and radiographic parameters, such as calcaneal pitch angle, talometatarsal angle (TMA), and talocalcaneal angle (TCA). Muscle thicknesses of the tibialis posterior (TP), peroneus longus (PL), and L1 multifidus were measured by sonography. Isometric contraction of ankle inversion, eversion in a seating position, and lumbar extension at a prone position were induced using a handheld dynamometer to measure the maximum muscle strength for each muscle. Beighton's scoring system was used to assess joint flexibility by evaluating the hyperextension of the joint for each category when performing stretching motion. Spearman's rank correlation coefficient for nonparametric data was used.

RESULTS

The FPI showed a moderately negative correlation with the muscle thickness of TP (r = -0.558, p = 0.009) and L1 multifidus (r = -0.527, p = 0.012), and the strength of the ankle inverter (r = -0.580 p = 0.005) and lumbar extensor (r = -0.436 p = 0.043). RCSPA showed a moderately positive correlation with TCA (r = 0.510, p = 0.006). Beighton's score showed no significant correlation with all parameters.

CONCLUSION

In children with flatfoot, FPI reflected the clinical severity; thus, the more severe the symptoms, the weaker the ankle inverter and lumbar extensor.

Comparison Of Short-Term Effects Of Virtual Reality and Short Foot Exercises In Pes Planus

BACKGROUND

Virtual reality exercises (VRE) offers functional, multipurpose usage with a motivational approach. This study aimed to compare VRE and short foot exercises (SFE) in individuals with flexible pes planus.

METHODS

Forty participants with pes planus were assigned to the SFE group (n = 20) or VR exercise group (n = 20). Both groups performed exercises three times a week for four weeks. The groups were assessed with a navicular drop test for the height of the medial longitudinal arch, craig Test for femoral anteversion, Star Excursion Test for balance,10 step test for performance.

RESULTS

For two groups there is a statistically significant difference between before and after treatments(p < 0.05). There is no difference between VRE and SFE groups after treatments for all parameters(p > 0.05).

CONCLUSIONS

Two different 4-week-exercise programs for pes planus have a similar effect on performance, balance, and navicular drop values in both groups. It was considered that the practice of VR exercises like short foot exercises could also address rehabilitation goals, which included improving balance, performance, and foot posture. CLINICALTRIALS.

GOV IDENTIFIER

NCT04283357.

Comparison of multiple flatfoot indicators in 5-8-year-old children

Background

The foot posture is age dependent. The purpose of this study was to investigate the relationship between the 6-item version of the foot posture index (FPI) and other clinical, foot anthropometric, radiological measurements for the foot position in 5–8-year-old children.

Methods

A total of 301 participants with a mean age of 6.4  ±  1.14 years were enrolled in the study. Children were examined physically, clinically, and radiologically to measure the FPI and navicular drop (ND) test, resting calcaneal stance position (RCSP) angle, Chippaux–Smirak index (CSI), Staheli index (SI), calcaneal pitch (CP) angle, talocalcaneal angle (TCA), and the first lateral metatarsal angle. Tibial torsions, internal rotation of the hip as an indirect method of femoral anteversion, and Beighton scale were analyzed for factors associated with flatfoot prevalence.

Results

The study included children with normal and flexible flatfeet. Statistical analysis showed a significant FPI score correlation with other parameters (SI, CSI, RCSP, ND, CP, TMA, and TCA showed strong and moderate correlations, p < 0.001). Overall, the strongest associates are CSI (β = 0.34) and ND (β = 0.28). Other indicators have relatively small relationships with the FPI.

Conclusion

A positive correlation was observed between FPI-6 and ND test, CSI in 5–8-year-old children. All three prominent foot posture indicators (FPI-6, ND, and CSI) might be used as a primary or preferred tool in clinical practice.

Changes in Resting Calcaneal Stance Position Angle Following Insole Fitting in Children With Flexible Flatfoot

Objective

To clarify the relationship of the initial radiologic and a biomechanical parameter at first clinical visit, and define the effectiveness of modified insole, following insole fitting in children with flexible flatfoot.

Methods

Children aged less than 13 years with flexible flatfoot were enrolled. The total number of subjects was 66 (33 boys, 33 girls). The subjects were divided into 5 subgroups, based on age: 1–2, 3–4, 5–6, 7–9, and 10–12 years. The mean time period between the initial & final examination for their resting calcaneal stance position angle (RCSPA) was 24 months. Radiography quantified the deformity by measuring angles, including the talometatarsal angle, the metatarsal angle, and the calcaneal pitch angle.

Results

From the angles measured on radiographs, only the talometatarsal angle showed a statistically significant correlation to the initial RCSPA (r=-0.578 for right side, r=-0.524 for left side; p<0.01). The mean RCSPA improved in all subgroups of subjects following insole fitting. Moreover, in children younger than 7 years, the improvement in RCSPA from the insole fitting was greater compared to children aged 7 years and older.

Conclusion

The insole has additionally beneficial effects in all populations younger than 13 years. However, there might exist a hidden effect of normal structural pedal alignment during growth accompanied with bony maturation and developmental process. To date, it is controversial whether the treatment of flexible flatfoot is necessary in the vast majority of cases, or simple observation and advice to parents would suffice.

The effect of backpack load on muscle activities of the trunk and lower extremities and plantar foot pressure in flatfoot

[Purpose] The purpose of this study was to investigate the changes in muscle activation of the trunk and lower extremities and plantar foot pressure due to backpack loads of 0, 10, 15, and 20% of body weight during level walking in individuals with flatfoot. [Methods] Fourteen young flatfoot subjects and 12 normal foot subjects participated in this study. In each session, the subjects were assigned to carry a backpack load, and there were four level walking modes: (1) unloaded walking (0%), (2) 10% body weight (BW) load, (3) 15% BW load, and (4) 20% BW load. Trunk and lower extremity muscle activities were recorded by surface EMG, and contact area and plantar foot pressure were determined using a RS scan system. [Results] The erector spinae, vastus medialis, tibialis anterior and gastrocnemius muscle activities, but not the rectus femoris and rectus abdominis muscle activities of flatfoot subjects significantly and progressively increased as load increased in flatfoot subjects. Contact area and pressure of the lateral and medial heel zones were significantly increased too. [Conclusion] Based on this data, the weight of a backpack could influence muscle activation and plantar foot pressure in flatfoot.