Measurement of plantar pressure distribution in hemiplegic children: changes to adaptative gait patterns in accordance with deficiency.

OBJECTIVE

A comparison of plantar pressure distribution in hemiplegic children with a healthy control group was performed to illustrate the link between the changing dynamics during the stance phase and the degree of deficiency.

DESIGN

Twenty three healthy control subjects and two groups of six hemiplegic children with minor and major spasticity were tested.

BACKGROUND

In previous studies, it was shown that the musculoskeletal dysfunction due to spasticity disturbed the hemiplegic gait pattern, for example reduced walking speed and step length. However, plantar pressure measurements which would help to understand the pathological gait mechanisms have not been studied.

METHODS

The stance phase parameters measured included spatio-temporal data and the relative impulse measurements during consecutive gait cycles. The relative impulses under eight plantar areas were determined with an in-shoe plantar pressure measurement device.

RESULTS

Each group had a specific plantar pressure distribution profile that varied with the degree of deficiency. The most significant differences were found beneath the midfoot, the first metatarsal head and the hallux.

CONCLUSION

The neuromuscular disorders and foot deformities due to the cerebral lesion modified the contact of the foot with the ground, and led to specific plantar pressure distribution profiles. The equinovarus, with clawed-toe deformity due to greater spasticity, seemed to be an important factor in disturbances of the terminal stance phase. However, the spastic hemiplegic subjects seemed to adopt a gait pattern required for optimal stability.

RELEVANCE

From previous work, comparable data were available only for the hemiparetic adult patients. In-shoe pressure data from spastic hemiplegic children can provide detailed information specific to each region of contact for the support of diagnosis, a clinical decision or the prescription of appropriate footwear, braces or othoses. Both peak pressure and local impulse have proven to be valuable for the understanding of foot function, lower extremity dysfunctions and walking strategies.