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O4: Cavovarus foot correction normalizes knee and hip abnormalities in Charcot-Marie-Tooth disease
Gait & Posture xxx (xxxx) xxx–xxx
Contents lists available at ScienceDirect
Gait & Posture journal homepage: www.elsevier.com/locate/gaitpost
O4
Cavovarus foot correction normalizes knee and hip abnormalities in Charcot-Marie-Tooth disease ⁎
Annika Wallroth , Britta Krautwurst, Nicholas Beckmann, Sebastian Wolf, Thomas Dreher University Hospital, Heidelberg, Germany
1. Introduction 4. Results Cavovarus foot deformity (CFD) is typical in patients suffering from Charcot-Marie-Tooth disease (CMT), the most frequent hereditary neurological disorder. Selective muscular atrophy of the foot und shank is followed by progressive bony deformity, flexible in the beginning may result in severe fixed pes cavovarus. Previous research showed that kinematics of the foot significantly improve after operative treatment of the CFD [2] but also need to be applied thoughtfully regarding to the underlying biomechanical conditions [1]. Gait deviations in patients with CFD may also be associated with alterations in transverse plane kinetics and kinematics [3,4], in terms of altered knee and hip rotation moments and supposed instability of the knee and patella. 2. Research question Does combined operative bony and soft-tissue correction of the CFD have an impact on kinetics and kinematics of the ankle, knee and hip? 3. Methods We examined 24 patients with CMT and bilateral CFD before and after foot reconstruction surgery including a standardized protocol of bony and soft-tissue procedures. In all cases both conventional plug-ingait analysis and the Heidelberg Foot Measurement Method were used to determine the sagittal, frontal and transverse plane kinematics and kinetics. Comparisons were done using descriptive statistics and linear mixed models to analyze the postoperative change. A p-value of 0.05 was used as cutoff for significance.
⁎
Corresponding author.
http://dx.doi.org/10.1016/j.gaitpost.2017.07.010
0966-6362/ © 2017 Elsevier B.V. All rights reserved.
3D gait analysis revealed significant reduction in hip abduction and external rotation of the hip and ankle during the stance phase after surgery. These changes were accompanied by significant alterations in the hip kinetics. Transverse plane hip rotation moment normalized significantly. Frontal plane hip and ankle abduction moments normalized postoperatively within the standard deviation of the mean normal reference. 5. Discussion CFD has an impact on the biomechanical integrity of the hip. Operative procedures of the CFD not only improve foot kinematics but also have a significant impact on the kinematics and kinetics of the knee and hip. External rotation of the hip and its kinetics normalized signifcantly. Frontal plane hip and ankle kinetics improved. This investigation shows the multi-level and multi-plane impact of bony and soft tissue correction on gait in patients with CFD in CMT. As long as those secondary abnormalities are not fixed they can be expected to vanish after foot reconstruction. References [1] [2] [3] [4]
Beckmann, J. Foot Ankle Res. 8 (65) (2015) 1–7. Dreher, J. Bone Jt. Surg. Am. 96 (2014) 456–462. Ferrarin, Gait Posture 35 (1) (2012) 131–137. Newman, Gait Posture 26 (2007) 120–127.
Contents lists available at ScienceDirect
Gait & Posture journal homepage: www.elsevier.com/locate/gaitpost
O4
Cavovarus foot correction normalizes knee and hip abnormalities in Charcot-Marie-Tooth disease ⁎
Annika Wallroth , Britta Krautwurst, Nicholas Beckmann, Sebastian Wolf, Thomas Dreher University Hospital, Heidelberg, Germany
1. Introduction 4. Results Cavovarus foot deformity (CFD) is typical in patients suffering from Charcot-Marie-Tooth disease (CMT), the most frequent hereditary neurological disorder. Selective muscular atrophy of the foot und shank is followed by progressive bony deformity, flexible in the beginning may result in severe fixed pes cavovarus. Previous research showed that kinematics of the foot significantly improve after operative treatment of the CFD [2] but also need to be applied thoughtfully regarding to the underlying biomechanical conditions [1]. Gait deviations in patients with CFD may also be associated with alterations in transverse plane kinetics and kinematics [3,4], in terms of altered knee and hip rotation moments and supposed instability of the knee and patella. 2. Research question Does combined operative bony and soft-tissue correction of the CFD have an impact on kinetics and kinematics of the ankle, knee and hip? 3. Methods We examined 24 patients with CMT and bilateral CFD before and after foot reconstruction surgery including a standardized protocol of bony and soft-tissue procedures. In all cases both conventional plug-ingait analysis and the Heidelberg Foot Measurement Method were used to determine the sagittal, frontal and transverse plane kinematics and kinetics. Comparisons were done using descriptive statistics and linear mixed models to analyze the postoperative change. A p-value of 0.05 was used as cutoff for significance.
⁎
Corresponding author.
http://dx.doi.org/10.1016/j.gaitpost.2017.07.010
0966-6362/ © 2017 Elsevier B.V. All rights reserved.
3D gait analysis revealed significant reduction in hip abduction and external rotation of the hip and ankle during the stance phase after surgery. These changes were accompanied by significant alterations in the hip kinetics. Transverse plane hip rotation moment normalized significantly. Frontal plane hip and ankle abduction moments normalized postoperatively within the standard deviation of the mean normal reference. 5. Discussion CFD has an impact on the biomechanical integrity of the hip. Operative procedures of the CFD not only improve foot kinematics but also have a significant impact on the kinematics and kinetics of the knee and hip. External rotation of the hip and its kinetics normalized signifcantly. Frontal plane hip and ankle kinetics improved. This investigation shows the multi-level and multi-plane impact of bony and soft tissue correction on gait in patients with CFD in CMT. As long as those secondary abnormalities are not fixed they can be expected to vanish after foot reconstruction. References [1] [2] [3] [4]
Beckmann, J. Foot Ankle Res. 8 (65) (2015) 1–7. Dreher, J. Bone Jt. Surg. Am. 96 (2014) 456–462. Ferrarin, Gait Posture 35 (1) (2012) 131–137. Newman, Gait Posture 26 (2007) 120–127.