Beckmann Nicholas A, Wolf Sebastian I, Heitzmann Daniel, Wallroth Annika, Müller Sebastian, Dreher Thomas
Clinic for Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200A, 69118 Heidelberg, Germany.
Heidelberg Motion Lab, Clinic for Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200A, 69118 Heidelberg, Germany.
J Foot Ankle Res. 2015 Nov 26;8:65. doi: 10.1186/s13047-015-0121-6. eCollection 2015.
Charcot-Marie-Tooth disease (CMT), one of the most common hereditary neurologic disorders, often results in debilitating cavovarus foot deformities. The deformities are still not fully understood, and the treatment recommendations are consequently heterogeneous, often including calf muscle or Achilles tendon lengthening.
We examined 40 patients (80 feet) with CMT and bilateral cavovarus deformities (19 men and 21 women, mean age 33.6 ± 14.6 years) and the feet of a healthy control population of 13 individuals (7 men and 6 women, mean age 43.9 ± 10.8 years). In all cases 3D instrumented gait analysis results with both conventional Plug-in-Gait analysis and the Heidelberg Foot Measurement Method (HFMM) were used to determine the sagittal plane kinematics, dorsi-plantar flexion (DPF), tibio-talar dorsiflexion (TTDF), and medial arch angle (MAA), and the results of patients and the control group were compared using the 2 methods. Decreased and increased dorsiflexion using TTDF was defined as 1 standard deviation below or above the mean of the control. Comparisons were done using descriptive statistics, the Pearson correlation coefficient and ANOVA.
The TTDF was found to be decreased in 18 of the 80 feet examined (22.5 %), normal in 31 feet (38.75 %), and increased in 31 feet (38.75 %). The Pearson coefficient showed a positive correlation with R = 0.765, p < 0.001 between decreased TTDF values found by HFMM and decreased DPF values found with conventional Plug-in-Gait analysis, but a very weak correlation in patients with normal TTDF (R = -0.118) and increased TTDF (R = 0.078). Also, in patients with decreased TTDF values, there was a weak to moderate correlation with the MAA (R = 0.335), but no correlation between the MAA and DPF (R = 0.023).
The HFMM, unlike the conventional Plug-in-Gait analysis, distinguishes between the segments of the foot in foot deformities and facilitates evaluation of the hindfoot equinus component in patients with CMT and cavovarus deformity. Although there is a significant correlation between decreased TTDF with HFMM and decreased DPF with conventional Plug-in-Gait analysis, this correlation was not seen in patients with normal or increased TTDF values. Conventional Plug-in-Gait analysis alone does not indicate if an increased plantar flexion deformity is the result of either a cavus deformity or hindfoot equinus deformity, which limits its usefulness in assisting in treatment decision making.
夏科-马里-图斯病（CMT）是最常见的遗传性神经疾病之一，常导致使人衰弱的高弓足畸形。这些畸形仍未被完全理解，因此治疗建议也各不相同，通常包括小腿肌肉或跟腱延长术。
我们检查了40例患有CMT和双侧高弓足畸形的患者（80只脚）（19名男性和21名女性，平均年龄33.6±14.6岁）以及13名健康对照者的脚（7名男性和6名女性，平均年龄43.9±10.8岁）。在所有病例中，使用传统的插件式步态分析和海德堡足部测量方法（HFMM）的三维仪器化步态分析结果来确定矢状面运动学、背屈-跖屈（DPF）、胫距背屈（TTDF）和内侧足弓角（MAA），并使用这两种方法比较患者和对照组的结果。使用TTDF测量的背屈减少和增加被定义为比对照组平均值低或高1个标准差。使用描述性统计、皮尔逊相关系数和方差分析进行比较。
在所检查的80只脚中，发现18只脚（22.5%）的TTDF降低，31只脚（38.75%）正常，31只脚（38.75%）升高。皮尔逊系数显示，HFMM发现的TTDF值降低与传统插件式步态分析发现的DPF值降低之间呈正相关，R = 0.765，p < 0.001，但在TTDF正常的患者中相关性非常弱（R = -0.118），在TTDF升高的患者中相关性也很弱（R = 0.078）。此外，在TTDF值降低的患者中，与MAA呈弱至中度相关（R = 0.335），但MAA与DPF之间无相关性（R = 0.023）。
与传统的插件式步态分析不同，HFMM能够区分足部畸形中足部的各个节段，有助于评估CMT和高弓足畸形患者的后足马蹄畸形成分。虽然HFMM测量的TTDF降低与传统插件式步态分析测量的DPF降低之间存在显著相关性，但在TTDF值正常或升高的患者中未发现这种相关性。仅传统的插件式步态分析无法表明跖屈畸形增加是高弓畸形还是后足马蹄畸形的结果，这限制了其在辅助治疗决策中的作用。
