Church Chris, Lennon Nancy, Lennon Madison, Henley John D, Shields Thomas, Niiler Tim, Taylor Daveda A, Shrader M Wade, Miller Freeman
Department of Orthopaedics, Nemours Children's Hospital Delaware, Wilmington, DE, USA.
J Child Orthop. 2024 Jan 19;18(1):3-12. doi: 10.1177/18632521231208746. eCollection 2024 Feb.
Foot deformities are prevalent in children with cerebral palsy, but there is limited research on the progression of foot posture during growth. Our study aimed to evaluate the change in dynamic foot posture in children with cerebral palsy.
Children with cerebral palsy, aged 17-40 months, were recruited to participate in this Institutional Review Board-approved prospective longitudinal study by having serial foot posture evaluations. The coronal plane index and foot segmental impulses were measured with dynamic pedobarography. Data were compared between children stratified by Gross Motor Function Classification System level and typically developing children using serial Welch's -tests across time with Holm correction for multiple comparisons.
In total, 33 children (54 limbs) were included in the analysis (21 bilateral and 12 unilateral; Gross Motor Function Classification System: I-13, II-14, III-4, IV-2. Children completed 16.9 (± 4.4) evaluations (initial age 2.9 (± 0.7) and final age 18.6 (± 1.7) years)). Early valgus foot posture normalizes in children at Gross Motor Function Classification System levels I/II and persists in children at levels III/IV who do not have foot surgery. For most young children, foot posture development is variable.
Foot posture in young children with cerebral palsy begins in valgus and tends to normalize in youth who walk without an assistive device. Conservative management of foot deformity is recommended in early childhood.
Level II, prognostic study.
足部畸形在脑瘫儿童中很常见，但关于生长过程中足部姿势进展的研究有限。我们的研究旨在评估脑瘫儿童动态足部姿势的变化。
招募17至40个月大的脑瘫儿童参与这项经机构审查委员会批准的前瞻性纵向研究，对其进行系列足部姿势评估。使用动态足底压力测量法测量冠状面指数和足部节段冲量。根据粗大运动功能分类系统水平对儿童进行分层，并与正常发育儿童进行比较，采用系列韦尔奇检验并进行霍尔姆多重比较校正。
共有33名儿童（54条肢体）纳入分析（21例双侧和12例单侧；粗大运动功能分类系统：I级-13例，II级-14例，III级-4例，IV级-2例。儿童完成了16.9（±4.4）次评估（初始年龄2.9（±0.7）岁，最终年龄18.6（±1.7）岁））。粗大运动功能分类系统I/II级的儿童早期外翻足部姿势会恢复正常，而未经足部手术的III/IV级儿童的外翻姿势会持续存在。对于大多数幼儿来说，足部姿势发育是可变的。
脑瘫幼儿的足部姿势始于外翻，在无需辅助设备行走的青少年中往往会恢复正常。建议在幼儿期对足部畸形进行保守治疗。
II级，预后研究。
