van den Heuvel Gaia, Buizer Annemieke I, Quirijnen Loes, Witbreuk Melinda M, van der Krogt Marjolein M, Schallig Wouter
Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands.
Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands; Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands; Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands.
Gait Posture. 2025 Mar;117:115-120. doi: 10.1016/j.gaitpost.2024.12.006. Epub 2024 Dec 9.
Foot deformities are common in cerebral palsy (CP) and are likely caused by a disturbed interplay of forces in the foot. Evaluation of foot joint moments would therefore be highly relevant. However, kinetic foot models have not previously been applied to children with CP.
What is the difference in multi-segment foot joint moments between children with CP with foot deformities and children with typically developing (TD) feet?
Children with spastic paresis were retrospectively included and compared to TD children. All children underwent clinical gait analysis, including a kinetic multi-segment foot model based on the Amsterdam Foot Model marker set. Internal joint moments of the ankle and midfoot (Chopart, Lisfranc) joints were calculated for each group.
67 feet of 40 children with spastic paresis (26 neutral, 25 planovalgus, 11 cavovarus, 5 equinovarus feet), and 15 feet of 15 TD children were included. Internal foot joint moments in children with CP with a cavovarus or equinovarus deformity showed an early ankle plantarflexion peak and increased valgus moments, increased Chopart plantarflexion and eversion moments, and increased Lisfranc abduction moments compared to TD feet. Planovalgus feet demonstrated early ankle plantarflexion and increased varus moments, increased Chopart adduction and reduced Lisfranc abduction moments compared to TD feet.
The direction of the differences found in cavovarus, equinovarus and planovalgus feet indicates that the internal joint moments are generally opposite to the malalignment of the foot. This indicates that external joint moments, which are caused by external forces and can be assumed to be opposite and equal to the internal moments, may contribute to further development of the deformity. Hence, the forces that cause deterioration of foot deformity in CP may not only be a result of muscle actions, but also of altered external loading due to abnormal foot alignment. This highlights the importance of early interventions to realign the foot to prevent deterioration of a foot deformity.
足部畸形在脑瘫（CP）中很常见，可能是由足部力量相互作用紊乱引起的。因此，评估足部关节力矩具有高度相关性。然而，动力学足部模型此前尚未应用于脑瘫儿童。
患有足部畸形的脑瘫儿童与足部发育正常（TD）的儿童在多节段足部关节力矩上有何差异？
回顾性纳入痉挛性麻痹儿童并与TD儿童进行比较。所有儿童均接受临床步态分析，包括基于阿姆斯特丹足部模型标记集的动力学多节段足部模型。计算每组踝关节和中足（Chopart、Lisfranc）关节的内部关节力矩。
纳入了40例痉挛性麻痹儿童的67只脚（26只中立脚、25只扁平外翻脚、11只高弓内翻脚、5只马蹄内翻脚）和15例TD儿童的15只脚。与TD足部相比，患有高弓内翻或马蹄内翻畸形的脑瘫儿童的足部内部关节力矩显示出早期踝关节跖屈峰值和外翻力矩增加、Chopart跖屈和外翻力矩增加以及Lisfranc外展力矩增加。与TD足部相比，扁平外翻脚表现出早期踝关节跖屈和内翻力矩增加、Chopart内收增加以及Lisfranc外展力矩减小。
在高弓内翻、马蹄内翻和扁平外翻脚中发现的差异方向表明，内部关节力矩通常与足部畸形方向相反。这表明由外力引起的外部关节力矩可能与内部力矩大小相等、方向相反，可能会导致畸形进一步发展。因此，导致脑瘫患儿足部畸形恶化的力量可能不仅是肌肉作用的结果，还可能是由于足部排列异常导致的外部负荷改变。这凸显了早期进行足部矫正干预以防止足部畸形恶化的重要性。
