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Assessment of the center of pressure line aids to detect subtle deformities after clubfoot treatment
Gait & Posture 49S (2016) 174
Contents lists available at ScienceDirect
Gait & Posture journal homepage: www.elsevier.com/locate/gaitpost
P35 presented in PS02: Poster teaser: Children (non-CP)
Assessment of the center of pressure line aids to detect subtle deformities after clubfoot treatment Barbara Callewaert 1,*, Kevin Deschamps 1,2, Kaat Desloovere 1,2, Anja Van Campenhout 3,4 1
CMAL, University Hospital Leuven, Leuven, Belgium KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium 3 KU Leuven, Department of Development & Regeneration, Leuven, Belgium 4 University Hospital Leuven, Department of Orthopaedics, Leuven, Belgium 2
Introduction: Pedobarography is a technical tool to assess the outcome after treatment for footpathology such as clubfeet. Until now most analysis focused on changes in discrete parameters such as maximum values of the center of pressure line (COP). Little analysis was done in 1-dimensional continuous way. Research question: The aim of the present study was to determine deviations in the COP line in young children with congenital clubfeet, treated by the Ponseti technique [1] compared to age-related typical developing children over the complete stance phase. Methods: 24 patients (age: 5.3 1.4 years, 17 boys, 6 girls) with 32 clubfeet participated in this study. 18 feet (age: 5.5 1.7 years) were treated using the Ponseti technique (G1), 15 feet (age: 5.1 0.8 years) had a Achilles tenotomy as part of the Ponseti treatment (G2). The number of Ponseti serial casts varied from 2 to 11 times. 6 typical developing boys (age 8.2 1.6 years) were recruited as comparison group (TDC). All data were obtained during barefoot walking at self-selected speed, using a Footscan1 pressure plate (2.8 sensors/cm2, 200 Hz). The medio-lateral (COP-X) and antero-posterior (COP-Y) component of the COP were calculated. For each subject 3 trials were averaged and normalized to 100% stance phase (S) as well as for foot length and width. Clinical evaluation included dorsiflexion range of motion by handheld goniometry. Onedimensional statistical parametric mapping (SPMt) [2] was used to compare the 3 groups. Results: SPMt results indicated no significant differences between G1 and G2 for COP-X and COP-Y. However a significant lateralization of the COP-X was found in G1 between 29 and 67%S (p < 0.001) and in G2 between 37 and 67%S (p < 0.001) as well as 77–98%S (p < 0.001) compared to TDC. Concerning the COP-Y, significant differences were observed in G1 between 4 and 5%S (p = 0.01) and in G2 between 0 and 8%S (p = 0.007) as well as 94–97%S (p = 0.002) compared to TDC. Clinical evaluation of
* Corresponding author. E-mail address: [email protected] (B. Callewaert). http://dx.doi.org/10.1016/j.gaitpost.2016.07.229 0966-6362/
ankle dorsiflexion showed reduced length for gastrocnemius in G1 (mean: 9.4 6.28) and in G2 (mean: 6.3 7.48), for soleus in G1 (mean: 15.3 8.88) and in G2 (mean: 11.3 9.58). No significant differences for dorsiflexion were found between G1 and G2. [TD$INLE]
Discussion: This study demonstrates the use of pedobarographic analysis as an objective tool as this provides quantitative information of the function of the treated clubfoot. Pedobarograph results indicate mild residual deformities in clubfeet despite clinically successful outcomes. In clubfeet we could recognize a clear lateralization of the COP compared TDC, during almost the whole stance phase, except for initial contact phase. However, in previous studies [3] only minimal changes could be found. Moreover, the Achilles tendon in children with clubfeet is discreetly shorter, therefore they use a smaller percentage of their foot length. All these findings can be useful in the manufacturing of insoles. References [1] Ponseti. et al. Clin. Orthop. Relat. Res. 2009. [2] Pataky. et al. J. Biomech. 2010. [3] Sinclar. et al. Clin. Orthop. Relat. Res. 2009.
Contents lists available at ScienceDirect
Gait & Posture journal homepage: www.elsevier.com/locate/gaitpost
P35 presented in PS02: Poster teaser: Children (non-CP)
Assessment of the center of pressure line aids to detect subtle deformities after clubfoot treatment Barbara Callewaert 1,*, Kevin Deschamps 1,2, Kaat Desloovere 1,2, Anja Van Campenhout 3,4 1
CMAL, University Hospital Leuven, Leuven, Belgium KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium 3 KU Leuven, Department of Development & Regeneration, Leuven, Belgium 4 University Hospital Leuven, Department of Orthopaedics, Leuven, Belgium 2
Introduction: Pedobarography is a technical tool to assess the outcome after treatment for footpathology such as clubfeet. Until now most analysis focused on changes in discrete parameters such as maximum values of the center of pressure line (COP). Little analysis was done in 1-dimensional continuous way. Research question: The aim of the present study was to determine deviations in the COP line in young children with congenital clubfeet, treated by the Ponseti technique [1] compared to age-related typical developing children over the complete stance phase. Methods: 24 patients (age: 5.3 1.4 years, 17 boys, 6 girls) with 32 clubfeet participated in this study. 18 feet (age: 5.5 1.7 years) were treated using the Ponseti technique (G1), 15 feet (age: 5.1 0.8 years) had a Achilles tenotomy as part of the Ponseti treatment (G2). The number of Ponseti serial casts varied from 2 to 11 times. 6 typical developing boys (age 8.2 1.6 years) were recruited as comparison group (TDC). All data were obtained during barefoot walking at self-selected speed, using a Footscan1 pressure plate (2.8 sensors/cm2, 200 Hz). The medio-lateral (COP-X) and antero-posterior (COP-Y) component of the COP were calculated. For each subject 3 trials were averaged and normalized to 100% stance phase (S) as well as for foot length and width. Clinical evaluation included dorsiflexion range of motion by handheld goniometry. Onedimensional statistical parametric mapping (SPMt) [2] was used to compare the 3 groups. Results: SPMt results indicated no significant differences between G1 and G2 for COP-X and COP-Y. However a significant lateralization of the COP-X was found in G1 between 29 and 67%S (p < 0.001) and in G2 between 37 and 67%S (p < 0.001) as well as 77–98%S (p < 0.001) compared to TDC. Concerning the COP-Y, significant differences were observed in G1 between 4 and 5%S (p = 0.01) and in G2 between 0 and 8%S (p = 0.007) as well as 94–97%S (p = 0.002) compared to TDC. Clinical evaluation of
* Corresponding author. E-mail address: [email protected] (B. Callewaert). http://dx.doi.org/10.1016/j.gaitpost.2016.07.229 0966-6362/
ankle dorsiflexion showed reduced length for gastrocnemius in G1 (mean: 9.4 6.28) and in G2 (mean: 6.3 7.48), for soleus in G1 (mean: 15.3 8.88) and in G2 (mean: 11.3 9.58). No significant differences for dorsiflexion were found between G1 and G2. [TD$INLE]
Discussion: This study demonstrates the use of pedobarographic analysis as an objective tool as this provides quantitative information of the function of the treated clubfoot. Pedobarograph results indicate mild residual deformities in clubfeet despite clinically successful outcomes. In clubfeet we could recognize a clear lateralization of the COP compared TDC, during almost the whole stance phase, except for initial contact phase. However, in previous studies [3] only minimal changes could be found. Moreover, the Achilles tendon in children with clubfeet is discreetly shorter, therefore they use a smaller percentage of their foot length. All these findings can be useful in the manufacturing of insoles. References [1] Ponseti. et al. Clin. Orthop. Relat. Res. 2009. [2] Pataky. et al. J. Biomech. 2010. [3] Sinclar. et al. Clin. Orthop. Relat. Res. 2009.