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The impact of laterality on gait in children with clubfoot
ESMAC Abstracts 2015 / Gait & Posture 42S (2015) S1–S101
Session OS13 Pediatric Gait The impact of laterality on gait in children with clubfoot E. Lööf 1,∗ , H. Andriesse 2 , E. Weidenhielm Broström 1 1 2
S61
The next step is to evaluate single gait parameters and GDI-kinetic to clarify differences and possible clinical impact. Reference [1] Schwartz MH, Rozumalski A. Gait Posture 2008;28:351–7.
http://dx.doi.org/10.1016/j.gaitpost.2015.06.114
Karolinska Institutet, Stockholm, Sweden Ortopediska kliniken, Lund, Sweden
Research question: Are there any differences in gait pattern between children with bilateral and unilateral clubfoot, including the unaffected foot, compared with typically developed children? Introduction: Previous studies of gait analysis in children with idiopathic clubfoot have evaluated all clubfeet as one homogenous group. Some studies imply that the unaffected foot cannot be used as a healthy reference. We wanted to evaluate the gait pattern and possible differences between children with bilateral and unilateral clubfoot including the unaffected foot. Materials and methods: A cross-sectional retrospective study of three-dimensional (3D) gait analysis of 59 children with idiopathic clubfoot (mean age 5.4 yrs) was conducted. The gait analyses were performed with a 3D eight-camera system (Vicon, Oxford Metrics) with two force plates (Kistler). Gait Deviation Index (GDI), a multivariate measure of the overall gait pathology [1], was calculated in order to present a quantitative value of gait kinematics. For gait kinetics the sum of generated positive work (J/kg) from the hip, knee and ankle was calculated and divided into percentage for each segment. The children were divided into groups of bilateral clubfoot (BCF, n = 30), unilateral clubfoot (UCF, n = 29) and unilateral unaffected foot (UUF). 28 typical developed children (TD, n = 28, mean age 5.5 yrs) were used as control subjects. Results: The GDI showed significant deviation in all groups (BCF 91.5, UCF 88.3 and UUF 91.2) compared to TD (100.0). Significant differences were found regarding total positive work and distribution between the segments in BCF and UCF with a shift from the foot to the hip compared to TD (Fig. 1). No differences were found between UUF and TD in either positive work or distribution. BCF compared to UCF revealed only a difference in percentage of work in the ankle. Discussion: The results indicate that only small differences in gait patterns exist between children with bilateral and unilateral clubfoot but both deviates significant from TD. The shift in positive work from the foot to the hip in both groups is interesting but should be interpreted with caution since no absolute numbers have been calculated. Moreover the unilateral unaffected foot deviated significantly from the TD in GDI though no significant shift in work/distribution was noted. This indicates that the child seems to alter gait motions in the unaffected foot to achieve gait symmetry.
Fig. 1. Total positive work and distribution in BCF 0.49 J/kg*, UCF 0.47 J/kg*, UUF 0.55 J/kg and TD 0.53 J/kg. *Sig. diff. to TD.
Session OS13 Pediatric Gait Gait deviations in transverse plane after SCFE in dependence of the femoral offset B. Westhoff 1,∗ , S. Pezaro 1 , D. Rosenthal 2 , C. Zilkens 1 , R. Krauspe 1 1
Universitätsklinikum Düsseldorf, Klinik und Poliklinik für Orthopädie, Düsseldorf, Germany 2 ITBB GmbH, Neukirchen-Vluyn, Germany Research question: It is hypothesized that patients after slipped capital femoral epiphysis (SCFE) show gait deviations in the transverse plane and coherency exists between the severity of offset-loss and external hip rotation. Introduction: Residual deformity of the femoral head after SCFE might be accompanied by a loss of femoral offset and may lead to femoro-acetabular impingement (FAI). This study aimed to analyze whether a decreased femoral offset leads to gait deviations in the transverse plane and whether the extent of deviations correlates with the severity of offset-loss. Materials and methods: 36 patients after SCFE (23 male, 13 female, average age 23.2 yrs, mean BMI 27.7), who were treated by pinning-in-situ, were included. Inclusion criteria: uni- or bilateral SCFE, age over 18 yrs, BMI below 40, follow-up of at least 3 yrs [1]. Exclusion criteria were any other disorder associated with gait deviations. On ap-radiographs the femoral offset was measured by the alpha-angle according to Nötzli [2]. Patients were divided into 3 offset-groups (OG): OG1 (n = 10) alpha angle below 50◦ , OG2 (n = 7) alpha angle 50–60◦ , OG3 (n = 19) alpha angle exceeding 60◦ . 3Dgait-analysis was performed with a VICON 512 system. Patients walked barfoot with self-selected speed. Results were compared to a group of adults with no gait deviations (n = 40, 7 male, 33 female, average age 28.4 yrs, mean BMI 21.9). For statistics Pearson correlation analysis and a one-way ANOVA of the controls and offset groups with Dunnett-T3 post-hoc comparisons were performed. Results: In comparison to the controls patients walked with increased external rotation of the hip; at maximum hip flexion (40–60% of the GC) maximum external hip rotation differs significantly across the groups (controls: 4.95◦ (5.81), OG1: −2.2◦ (8.46), OG2: −3.63◦ (9.79), OG3: −7.38◦ (8.71), p < 0.001). Maximum external hip rotation during 40–60% of the GC is significantly correlated with the alpha angle within the patients (r = −0.38, p = .03. There is also a significant correlation between the range of motion (ROM) of the pelvis in the transverse plane and the alpha angle (r = .484, p < .001). Across the groups ROM of the pelvis is significantly different (controls: 10.37◦ (4.5), OG1: 6.02◦ (2.27), OG2: 8.24◦ (2.33), OG3: 8.31◦ (2.44), p < .001), with the largest differences between OG1 and controls (p < .001). There were no differences in terms of degenerative joint disease between the offset groups. Discussion: Residual deformity of the proximal femur after SCFE leads to increased external hip rotation during gait. The results of this study suggest that with decreasing femoral offset in SCFE more external rotation is needed to avoid FAI.
Session OS13 Pediatric Gait The impact of laterality on gait in children with clubfoot E. Lööf 1,∗ , H. Andriesse 2 , E. Weidenhielm Broström 1 1 2
S61
The next step is to evaluate single gait parameters and GDI-kinetic to clarify differences and possible clinical impact. Reference [1] Schwartz MH, Rozumalski A. Gait Posture 2008;28:351–7.
http://dx.doi.org/10.1016/j.gaitpost.2015.06.114
Karolinska Institutet, Stockholm, Sweden Ortopediska kliniken, Lund, Sweden
Research question: Are there any differences in gait pattern between children with bilateral and unilateral clubfoot, including the unaffected foot, compared with typically developed children? Introduction: Previous studies of gait analysis in children with idiopathic clubfoot have evaluated all clubfeet as one homogenous group. Some studies imply that the unaffected foot cannot be used as a healthy reference. We wanted to evaluate the gait pattern and possible differences between children with bilateral and unilateral clubfoot including the unaffected foot. Materials and methods: A cross-sectional retrospective study of three-dimensional (3D) gait analysis of 59 children with idiopathic clubfoot (mean age 5.4 yrs) was conducted. The gait analyses were performed with a 3D eight-camera system (Vicon, Oxford Metrics) with two force plates (Kistler). Gait Deviation Index (GDI), a multivariate measure of the overall gait pathology [1], was calculated in order to present a quantitative value of gait kinematics. For gait kinetics the sum of generated positive work (J/kg) from the hip, knee and ankle was calculated and divided into percentage for each segment. The children were divided into groups of bilateral clubfoot (BCF, n = 30), unilateral clubfoot (UCF, n = 29) and unilateral unaffected foot (UUF). 28 typical developed children (TD, n = 28, mean age 5.5 yrs) were used as control subjects. Results: The GDI showed significant deviation in all groups (BCF 91.5, UCF 88.3 and UUF 91.2) compared to TD (100.0). Significant differences were found regarding total positive work and distribution between the segments in BCF and UCF with a shift from the foot to the hip compared to TD (Fig. 1). No differences were found between UUF and TD in either positive work or distribution. BCF compared to UCF revealed only a difference in percentage of work in the ankle. Discussion: The results indicate that only small differences in gait patterns exist between children with bilateral and unilateral clubfoot but both deviates significant from TD. The shift in positive work from the foot to the hip in both groups is interesting but should be interpreted with caution since no absolute numbers have been calculated. Moreover the unilateral unaffected foot deviated significantly from the TD in GDI though no significant shift in work/distribution was noted. This indicates that the child seems to alter gait motions in the unaffected foot to achieve gait symmetry.
Fig. 1. Total positive work and distribution in BCF 0.49 J/kg*, UCF 0.47 J/kg*, UUF 0.55 J/kg and TD 0.53 J/kg. *Sig. diff. to TD.
Session OS13 Pediatric Gait Gait deviations in transverse plane after SCFE in dependence of the femoral offset B. Westhoff 1,∗ , S. Pezaro 1 , D. Rosenthal 2 , C. Zilkens 1 , R. Krauspe 1 1
Universitätsklinikum Düsseldorf, Klinik und Poliklinik für Orthopädie, Düsseldorf, Germany 2 ITBB GmbH, Neukirchen-Vluyn, Germany Research question: It is hypothesized that patients after slipped capital femoral epiphysis (SCFE) show gait deviations in the transverse plane and coherency exists between the severity of offset-loss and external hip rotation. Introduction: Residual deformity of the femoral head after SCFE might be accompanied by a loss of femoral offset and may lead to femoro-acetabular impingement (FAI). This study aimed to analyze whether a decreased femoral offset leads to gait deviations in the transverse plane and whether the extent of deviations correlates with the severity of offset-loss. Materials and methods: 36 patients after SCFE (23 male, 13 female, average age 23.2 yrs, mean BMI 27.7), who were treated by pinning-in-situ, were included. Inclusion criteria: uni- or bilateral SCFE, age over 18 yrs, BMI below 40, follow-up of at least 3 yrs [1]. Exclusion criteria were any other disorder associated with gait deviations. On ap-radiographs the femoral offset was measured by the alpha-angle according to Nötzli [2]. Patients were divided into 3 offset-groups (OG): OG1 (n = 10) alpha angle below 50◦ , OG2 (n = 7) alpha angle 50–60◦ , OG3 (n = 19) alpha angle exceeding 60◦ . 3Dgait-analysis was performed with a VICON 512 system. Patients walked barfoot with self-selected speed. Results were compared to a group of adults with no gait deviations (n = 40, 7 male, 33 female, average age 28.4 yrs, mean BMI 21.9). For statistics Pearson correlation analysis and a one-way ANOVA of the controls and offset groups with Dunnett-T3 post-hoc comparisons were performed. Results: In comparison to the controls patients walked with increased external rotation of the hip; at maximum hip flexion (40–60% of the GC) maximum external hip rotation differs significantly across the groups (controls: 4.95◦ (5.81), OG1: −2.2◦ (8.46), OG2: −3.63◦ (9.79), OG3: −7.38◦ (8.71), p < 0.001). Maximum external hip rotation during 40–60% of the GC is significantly correlated with the alpha angle within the patients (r = −0.38, p = .03. There is also a significant correlation between the range of motion (ROM) of the pelvis in the transverse plane and the alpha angle (r = .484, p < .001). Across the groups ROM of the pelvis is significantly different (controls: 10.37◦ (4.5), OG1: 6.02◦ (2.27), OG2: 8.24◦ (2.33), OG3: 8.31◦ (2.44), p < .001), with the largest differences between OG1 and controls (p < .001). There were no differences in terms of degenerative joint disease between the offset groups. Discussion: Residual deformity of the proximal femur after SCFE leads to increased external hip rotation during gait. The results of this study suggest that with decreasing femoral offset in SCFE more external rotation is needed to avoid FAI.