Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Gait Posture. 2020 Feb;76:141-145. doi: 10.1016/j.gaitpost.2019.12.002. Epub 2019 Dec 12.
Out-toeing is common in children with cerebral palsy (CP), contributing to lever arm dysfunction and functional limitations. It is important to determine the cause(s) of out-toeing prior to treatment, whether surgical or non-surgical.
What are the contributors to out-toeing in children with CP and do they differ between children with bilateral and unilateral involvement?
The causes of out-toeing gait were determined retrospectively, with the use of computerized gait analysis, in 261 children with cerebral palsy (344 sides). The prevalence of various causes was calculated separately for children with bilateral and unilateral involvement, and compared statistically between groups using Fisher's Exact analysis.
The most common cause of out-toeing was pes valgus in bilaterally involved subjects (71%) and pelvic external rotation (64%) in unilaterally involved subjects. Over half of the cases of out-toeing were due to multiple causes: 62% of the unilateral group and 53% of the bilateral group. In limbs with multiple causes of out-toeing in the bilateral group, pes valgus was one of the causes in 91% of limbs (146/161), and was most commonly combined with hip external rotation (27%), pelvic external rotation (22%), or external tibial torsion (20%). For the unilateral group with multiple causes of out-toeing, pelvic external rotation was one of the causes in 83% of limbs (20/24) and hip external rotation in 63% (15/24). Both were present (with or without additional causes) in 46% (11/24) of such limbs.
The causes of out-toeing are multifactorial in over half of affected limbs of children with cerebral palsy. They also differ for children with bilateral and unilateral involvement. These findings should be carefully considered prior to non-surgical or surgical treatment of out-toeing gait in these patients, to allow all sites of pathology to be addressed, and to optimize outcomes.
足外翻在脑瘫儿童中很常见，会导致力臂功能障碍和功能受限。在进行治疗（无论是手术还是非手术治疗）之前，确定足外翻的原因非常重要。
脑瘫儿童足外翻的原因是什么，双侧和单侧受累的儿童之间是否存在差异？
使用计算机步态分析，回顾性确定 261 名脑瘫儿童（344 侧）的足外翻步态的原因。分别计算双侧和单侧受累儿童各种原因的发生率，并使用 Fisher 精确检验对组间进行统计学比较。
双侧受累儿童中最常见的足外翻原因是足内翻（71%），单侧受累儿童中最常见的原因是骨盆外旋（64%）。超过一半的足外翻病例是由多种原因引起的：单侧组占 62%，双侧组占 53%。在双侧组中，有多种原因导致足外翻的肢体中，91%（146/161）的肢体存在足内翻，最常见的合并原因是髋关节外旋（27%）、骨盆外旋（22%）或胫骨外旋（20%）。对于单侧组中存在多种原因导致足外翻的肢体，骨盆外旋是 83%（20/24）的原因，髋关节外旋占 63%（15/24）。这两种情况在 46%（11/24）的肢体中同时存在（伴有或不伴有其他原因）。
脑瘫儿童受累肢体中，超过一半的足外翻原因是多因素的，双侧和单侧受累儿童的原因也不同。在对这些患者的足外翻步态进行非手术或手术治疗之前，应仔细考虑这些发现，以确保解决所有病变部位，并优化治疗效果。
