Alonso-Vázquez A, Villarroya M A, Franco M A, Asín J, Calvo B
Aragón Institute for Engineering Research (I3A), University of Zaragoza, Spain.
Gait Posture. 2009 Feb;29(2):214-9. doi: 10.1016/j.gaitpost.2008.08.009. Epub 2008 Oct 1.
Forefoot varus is a static deformity not easy to assess clinically. If left uncorrected, it is thought to affect both the posture of the patient and the kinematics of their lower limbs, and even the spine. Three-dimensional gait assessment could help to confirm forefoot varus diagnosis and provide objective evidence of the functional adaptive mechanisms postulated in the literature. The recently available Oxford Foot Model was used, simultaneously with a conventional lower limb model, to compare the kinematics of 10 forefoot varus children (aged 8-13) and 11 healthy controls (aged 7-13) during gait. Data acquisition was performed using a six-camera motion capture system, with a total of 27 reflective markers. A patient-by-patient comparison with the controls suggested several compensation patterns, although statistically significant differences were found only for the mean values of hip adduction/abduction during load response and midstance and hip flexion/extension during pre-swing. A multivariate statistical technique was used to determine which of the measured variables better separated both groups. The best discriminant model presented here includes hip adduction/abduction during load response, hindfoot/tibia inversion/eversion during pre-swing, hindfoot/tibia dorsiflexion/plantar flexion during load response and arch height during midstance, providing a rate of correct classification of 81%. The results could not fully confirm the kinematic relationships suggested in the literature. The small degree of forefoot varus deformity present in the patient group could have prevented other variables from becoming discriminant. A larger patient sample would help determine the possible different compensatory patterns to different degrees of forefoot varus.
前足内翻是一种静态畸形，临床上不易评估。如果不加以纠正，据认为它会影响患者的姿势以及下肢的运动学，甚至还会影响脊柱。三维步态评估有助于确认前足内翻的诊断，并为文献中假设的功能适应性机制提供客观证据。研究使用了最近可用的牛津足模型，并与传统的下肢模型同时使用，以比较10名前足内翻儿童（8至13岁）和11名健康对照者（7至13岁）在步态过程中的运动学。使用六相机运动捕捉系统进行数据采集，共使用27个反光标记。逐患者与对照组进行比较显示出几种代偿模式，尽管仅在负重反应和支撑中期期间髋关节内收/外展的平均值以及摆动前期期间髋关节屈伸的平均值方面发现了统计学上的显著差异。使用多元统计技术来确定哪些测量变量能更好地区分两组。这里呈现的最佳判别模型包括负重反应期间的髋关节内收/外展、摆动前期期间后足/胫骨内翻/外翻、负重反应期间后足/胫骨背屈/跖屈以及支撑中期期间的足弓高度，正确分类率为81%。结果未能完全证实文献中提出的运动学关系。患者组中存在的前足内翻畸形程度较小，可能阻止了其他变量成为判别变量。更大的患者样本将有助于确定针对不同程度前足内翻可能存在的不同代偿模式。
