Common Gait Abnormalities of Each Joint in Children with Spastic Cerebral Palsy

OBJECTIVE: To investigate the prevalence of gait abnormalities of each joint of lower legs in children with spastic cerebral palsy (CP) and to find out the influences of subtype of CP, age, previous surgery and motor function on the gait abnormalities. METHOD: The gait analysis and foot scan from 320 children with CP were reviewed. Types of gait abnormalities were classified into 5 types for hip joint, 4 types for knee joint and 8 types for foot and ankle joint. The prevalence of gait abnormalities was assessed and the influence of subtype of CP, age, previous surgery and GMFCS (gross motor function classification system) level were also investigated. RESULTS: In foot and ankle joint, intoeing (63.8%) was the most common in all CP. In knee joint, jumping knee (32.8%) was the most common in diplegic and hemiplegic CP but crouch (47.6%) was the most common in quadriplegic CP. The likelihood of having planovalgus and crouch significantly increased with age and pes calcaneus increased after orthopaedic surgery. The children with lower functional level on GMFCS tended to show stiff and recurvatum knee pattern. CONCLUSION: Predominent gait abnormalities in each joint were assessed. Age, previous surgery, motor function and subtype of children with CP had a significant effect on the prevalence of gait abnormalities in each joint.

Characteristics of Foot Pressure Distribution with or without Partial Prosthetic Foot in Transmetartarsal Amputee / 대한족부족관절학회지

PURPOSE: This study was designed to evaluate characteristics of foot pressure distribution with or without partial prosthetic foot in transmetatarsal amputee. MATERIALS AND METHODS: The subjects were 9 transmetatarsal amputees. Foot pressures were measured at hallux, the 1st-5th metatarsal head (MTH), mid-foot, condyle area by F-scan system in amputated or contralateral foot during active walking. RESULTS: In amputated foot, mean peak pressure was greatest in midfoot without prosthetic foot but it was greatest in hindfoot with prosthetic foot. In unaffected foot, although mean peak pressure was higher in hallux, and 1-5th MTH compared to amputated foot, it was greatest in hind foot both with and without prosthetic foot. However, in unaffected foot, mean peak pressure significantly decreased in hallux and 5th MTH after wearing the prosthetic foot. There was a significant difference in mean peak pressure in hallux and 5th MTH between amputated and unaffected foot after wearing prosthetic foot. However, other region had no significant difference with or without prosthetic foot between feet. CONCLUSIONS: The use of partial prosthetic foot tends to shift weight bearing from the heel area to forefoot and could significantly reduce hind foot peak pressure and redistributed to peak pressure. The partial prosthetic foot can also offer the peak pressure to reduction both amputated foot and unaffected foot and help to toe off during walking.

Analysis of the plantar pressure distribution of the normal Chinese adult / 中国矫形外科杂志

[Objective] To research the plantar pressure distribution of the normal Chinese adult. [Method] The F-scan plantar pressure analysis system was used to collect plantar pressure distribution data of 100 volunteers who stand, walk, jog, go upstairs and downstairs.The plantar pressure distribution data of 5 kinds of physiological states, as well as influence of sex, height, body weight, body mass index and speed was analyzed. [Result] There's different characteristic between 5 kinds of states of the plantar pressure distribution in the Chinese normal adults. There's significant difference between static and dynamic. In four dynamic motions, the gait of walk was stalest, and it became unstable if speed up and go upstairs or downstairs. As for the influential factors of the plantar pressure distribution, there was non-significance of sex. But the speed had the significance. The height, the body weight, the BMI had weak correlation with the plantar pressure distribution. [Conclusion] The plantar pressure distribution of normal Chinese adults has the distinctive quality. The data obtained by this experiment, may provide the reference for the clinical plantar pressure analysis.

The Changes of Foot Pressure Distribution in Spastic Cerebral Palsy with Equinus Deformity following Corrective Surgery

OBJECTIVE: The aim of this study was to identify the changes of pressure distribution on the foot after orthopaedic surgery for equinus deformity in spastic cerebral palsy using F-scan system. METHOD: Twenty-one children with spastic cerebral palsy were participated in this study. They had equinus deformity on foot and received soft tissue surgery. Pressure distribution on foot was measured before and after operation using F-scan system (Tekscan Inc., USA). Paired t-test was used in comparison of preoperative and postoperative measurements for statistical analysis. RESULTS: Total contact area, contact length, midfoot and hindfoot contact width were significantly increased after operation. Relative impulses of medial and lateral forefoot were significantly decreased and relative impulse of hindfoot significantly increased after operation (p<0.05). Anteroposterior distance of center of pressure (COP) and velocity of COP were significantly increased and mediolateral distance and slope of COP were significantly decreased after operation (p<0.05). CONCLUSION: This study revealed that patterns of foot pressure distribution during walking were significantly improved after operation. Therefore, these findings suggested that F- scan system might be useful for surgical outcome measurement for foot deformities in the children with spastic cerebral palsy.

The Characteristics of Foot Pressure in Children with Mild Spastic Diplegic Cerebral Palsy Related to Medial Arch Formation

OBJECTIVE: To find out the characteristics of foot pressure in children with mild spastic diplegic cerebral palsy over 7 years old compared with those of normal children. METHOD: Twenty children with mild spastic diplegic cerebral palsy and fourteen normal children over 7 years old articipated in this study. The foot was divided into 7 portions and then foot contact area, pressure of each foot portion and pathway of center of pressure (COP) were measured and analyzed by F-scan system (Tekscan Inc., USA) RESULTS: In children with cerebral palsy, first metatarsal area MET1) showed the highest relative impulse followed by MET2/3, hindfoot and hallux. Relative impulse of hallux, MET1 and medial midfoot were significantly higher in cerebral palsied than in normal children, while that of hindfoot was significantly lower in cerebral palsied than in normal children. Anteroposterior ratio of COP and gait velocity were significantly lower in cerebral palsied than in normal children. CONCLUSION: The characteristics of foot pressure distribution and the pathway of COP in children with mild spastic diplegic cerebral palsy were identified by quantitative analysis by F-scan system. Foot scan could be used for eval uating the foot pathology in children with cerebral palsy during gait.

Foot Pressure Distribution and Path of Center of Pressure (COP) of Foot during Ambulation in the Children with Spastic Cerebral Palsy

OBJECTIVE: To find out the characteristics of the foot pressure distribution and the path of center of pressure (COP) in the children with cerebral palsy, compared with normal control children. METHOD: Twenty-four children with spastic cerebral palsy(CP) and 38 normal children were participated in this study. The parameters of foot contact, plantar pressure and COP were measured using F-scan system (Teksan Inc.) with pressure ensitive insoles inserted in the shoes. RESULTS: The total contact area, mid foot contact width and also the pressure of hallux and medial side of mid foot were significantly higher in the children with CP than in normal controls. While the pressure of hind foot was significantly lower in the children with CP compared with normal controls. Anteroposterior distance and velocity of COP were significantly lowered in the cerebral palsied children. The paths of COP of both groups were directed inwardly without any significant differences between both groups. CONCLUSION: We can identify the characteristics of the foot pressure distribution and the path of COP in the children with spastic CP using F-scan system. These quantitative data of foot scan may be useful for evaluating the foot pathology during the gait in the children with CP.

The Changes of Plantar Pressure and Pathway of Center of Pressure in Foot during the Gait in Normal Preschool Children with Age

OBJECTIVE: To find out the changes of the plantar pressure distribution of foot and the pathway of center of pressure (COP) in normal preschool children with age. METHOD: Thirty-eight normal children aged 1 to 6 were participated in this study. We divided into three groups according to the age. Foot contact area, pressure of the foot and pathway of COP were measured using F-scan in-shoe measuring system (Tekscan Inc.) during the gait. RESULTS: The ratio of midfoot contact width to forefoot contact width was decreased with age (p<0.05). And the relative pressure of the medial midfoot was decreased with age (p<0.05). In the analysis of COP, the ratio of anteroposterior length of COP to total contact length was significantly increased (p<0.05), and the ratio of mediolateral width of COP to forefoot contact width was tend to decrease. CONCLUSION: We can identify the characteristics and changes of the foot pressure distribution and the pathway of COP in preschool children with normal foot using F-scan system. These quantitative data of foot scan are useful for evaluating the foot pathology in preschool children during the gait.

The Path of Center of Pressure(COP) of the Foot during Walking

Variations in the distribution and the magnitude of the forces in the foot may reflect painful conditions and abnormalities of structure or function. By tracking the path of the instantaneous COP(center of pressure) during stance phase, the balance and pattern of progression can be determined, but parameters on COP have not been standardized nor widely applied to clinical settings yet. To quantify the COP parameters and to evaluate the clinical applicability of COP, within subject experimental design was used. Twenty six subjects with age of sixties who had no history of foot problems were recruited. Foot contact and COP parameters were measured and compared between flat foot, low heel and high heel shod walking. 1) Gait cycle parameters, 2) foot contact parameters such as total contact area, contact length, contact width, and 3) COP parameters such as initial contact COP, mean COP, anteroposterior and mediolateral displacement of COP, slope of COP, velocity of COP during each functional rocker were measured with F-scan pressure sensitive insole system. In normal flat foot walking, COP of initial contact and mean COP were anatomically correspond to the center of the heel and to the center of the sole respectively. COP displacements corresponded to 83% of foot contact length anteroposteriorly and 18% of forefoot contact width mediolaterally. Slope of COP was about 6 degrees inwardly directed. Velocities of the COP during each functional rocker action were even and about 22-27 cm/sec around. In high heel shod walking, COP of initial contact was displaced 1.73 cm anteriorly and mean COP was displaced 0.31 cm medially and 1.89 cm anteriorly. Anteroposterior displacement of COP was also reduced. Velocity of the COP during heel rocker was faster and velocity during ankle rocker was slower compared to flat foot walking, which suggests excessive heel rocker and reduced ankle rocker action in high heel shod walking. In conclusion, COP parameters measured by pressure sensitive insole system may reflect the biomechanical alteration of the foot quantitatively and may be useful in assessing the biomechanical function of the foot.

Effect of Ankle Foot Orthosis on Hemiplegic Gait

Hemiplegic gait is characterized by slow and poorly coordinated movements of the affected limb resulting from foot drop or equinus deformities. Ankle-foot orthoses(AFO) are frequently prescribed to improve the gait pattern of hemiplegics. Plastic AFO with different trimlines in controlling ankle motion can cause variable biomechanical effects. In this study, we analysed the biomechanical effect of donning AFO on hemiplegic gait and assessed whether any differences resulted when the AFO was modified. Gait events, plantar pressure, foot contact and centers of pressure(COP) parameters were measured with F-scan pressure sensitive insole system in 21 hemiplegic stroke patients with Brunnstrom's lower extremity stage 3. And those parameters were compaired in each of four different conditions: 1) before donning AFO, 2) donning AFO without any modification, 3) donning AFO with the dis tal part of metatarsal head trimmed off, 4) donning AFO with third condition and weaning a cushioned heel shoes. After donning AFO, total contact area and contact width were increased, and initial contact COP and mean COP were displaced medially. But contact length was not changed and initial contact COP and mean COP were not displaced anteroposteriorly. Anteroposterior displacement of COP, slope and velocity of COP were not also changed after donning AFO. Among various AFO adjustments, there were no significant changes of plantar pressure, foot contact and COP parameters. The results suggest that 1) AFO provides mediolateral stability, but does not provide additional functional rocker actions during stance phase and 2) There were no definite different biomechanical actions among various adjustments of plastic AFO in hemiplegic gait of Brunnstrom's lower extremity stage 3.