Self-perceived foot function and pain in children and adolescents with flexible flatfeet - Relationship between dynamic pedobarography and the foot function index.

BACKGROUND: There is considerable debate as to which parameters to include in the assessment of paediatric flatfeet. Dynamic pedobarography is an objective, dynamic method to measure foot function. Information about its associations to patient-reported measures may help to focus on the most relevant parameters. RESEARCH QUESTION: What is the association between the Foot Function Index and pedobarographic assessments in flatfeet of children and adolescents? METHODS: A consecutive clinical case series of 51 participants with idiopathic flexible flatfeet aged 7-17 years underwent barefooted pedobarography during gait and completed the Foot Function Index Questionnaire. Pedobarographic data categorized into values related to area, peak pressure and force with respect to the hind-, mid- and forefoot were extracted. To test the associations between the Foot Function Index and pedobarographic assessments, bivariate partial correlations were tested and contact times served as co-variate. RESULTS: Several significant associations between peak pressure or forces beneath the hindfoot, midfoot and hallux to self-perceived function were found (|rho| = 0.28-.46, P < 0.05). In particular, reduced peak forces and pressures underneath the hindfoot and hallux, a lateral shift (smaller medio-lateral ratios) of hindfoot pressure and force and a medial shift (larger medio-lateral ratios) of midfoot pressure seem to be negatively associated with foot-related disability. Overall, less evidence was noted for associations to pain scores. Area related outcomes (including the arch index) contained no information for function while a larger BMI was the strongest thread for disability (rho = 0.42, P = 0.002) and pain (rho = 0.31, P = 0.027). SIGNIFICANCE: When using pedobarography for the assessment of flexible flatfeet of children and adolescents, less attention should be paid to area related measurements which do not provide information about self-perceived function or disability. Instead, peak pressures or forces in the hind- or midfoot or beneath the hallux may be focussed. Weight reductions are potentially an effective strategy to reduce or prevent symptoms.

Joint Mechanics After Total Knee Arthroplasty While Descending Stairs.

BACKGROUND: Modern knee designs do not fully restore the anatomy and kinematics of the natural knee. This study evaluates the kinematic and kinetic changes of well-functioning patients with total knee arthroplasty (TKA) in comparison to a healthy age-matched control group while descending stairs and level walking. The aim was to have a baseline for further investigations of TKA patients with problems. METHODS: Fifteen patients satisfied with TKA (8♀/7♂; 66.8 ± 7.4 years; body mass index (BMI) 25.9 ± 2.8 kg/m2; 2.1 ± 1.3 years postop, LCS Complete) and 17 healthy control subjects (7♀/10♂; 66.6 ± 6.8 years; BMI 25.0 ± 2.2 kg/m2) participated in the study. Kinematic (upper and lower body) and kinetic (lower body) data were collected during stair descending (step height 17 cm) and level walking, using an 8-camera Vicon system and 2 force plates. Parameters were compared using a Student t test. RESULTS: Patients after TKA showed significantly lower frontal knee moments and a more externally rotated hip during stance for both level walking and stair descent. There were 31% more significantly different parameters during level walking than during stair descent. CONCLUSION: The analysis of stair descending in addition to level walking for satisfied patients does not add additional information for the understanding of the kinematic and kinetic changes after TKA. It seems more important to include the kinematics and kinetics of the hip and ankle joint in all 3-dimensional planes.

Stair dimension affects knee kinematics and kinetics in patients with good outcome after TKA similarly as in healthy subjects.

Joint biomechanics during stair walking may contain important information on functional deficits in patients with orthopaedic conditions but depend on the stair dimension. The goal of this study was to compare knee kinematics and kinetics between patients with good outcome 2 years after total knee arthroplasty (TKA) and age-matched controls during stair ascent and descent at two different stair heights. Principal component analysis was used to detect differences in gait mechanics between 15 patients and 15 controls at different stair conditions. Linear mixed models showed differences in knee kinematic and kinetic patterns (in flexion/extension and abduction/adduction) between stair heights. The knee adduction angle was more affected by stair heights in stair ascending whereas knee adduction moment and knee power were more affected during stair descent. Some stair by height and subject effects were small but not significant. Overall, good outcome after TKA is reflected in close-to-normal knee biomechanics during stair walking. Specific stair configuration must be considered when comparing joint biomechanics between subject groups and studies. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1753-1761, 2016.

Gait deviations and compensations in pediatric patients with increased femoral torsion.

Coxa antetorta describes an abnormal torsion of the femur. It is commonly considered a cosmetic problem and is treated surgically only in severe cases and the presence of physical complaints. The purpose of this study was to identify deviations in gait kinematics and kinetics in pediatric patients caused by coxa antetorta and to categorize these deviations into primary and secondary deviations. We conducted a retrospective, cross-sectional three-dimensional (3D) gait analysis study to detect gait deviations in adolescents (n = 18; age range 10.5-17.5 years) with coxa antetorta compared to age-matched healthy control subjects (n = 17). Principal component (PC) analysis was used for data reduction. Linear mixed models applied to PC-scores were used to estimate the main effects within retained PCs followed by a post-hoc subgroup analysis. Patients walked with smaller external foot progression angle, greater knee adduction, more internally rotated and flexed hips and greater anterior pelvic tilt. Subgroup analysis revealed that-depending on knee alignment-patients had higher knee and hip adduction moments. These deviations in joint kinematics and kinetics may be associated with physical complaints and accelerated development of osteoarthritis. Assessment of gait deviations related to coxa antetorta using 3D gait analysis may be an additional tool in individual clinical decision-making.