Objective Signs of Foot Deformities in Children with Spastic Form of Cerebral Paralysis: Justification of Individual Approach to Footwear Support

Abstract

Relevance. Foot deformities are the most common locomotor pathology in children with infantile cerebral paralysis. At the same time many children suffering from this pathology wear standard shoes that do not take into account the individual foot anatomy. Purpose of the study — to justify the expedience of individual approach to orthopaedic support for children with infantile cerebral paralysis. Materials and methods. The authors examined 220 feet in 110 patients aging from 3 to 18 years: 62 patients with spastic form of infantile cerebral paralysis and 48 children who were examined during periodic screening at general education institutions (control group). Clinical examination methods, computerized plantography and podometry by flatbed foot scanning (ventrally, posteriorly, medially) in standing position were used in the present study. Results. Statistically significant variances (p*<0.005) were obtained for 8 indicators of foot deformity in three planes in children with infantile cerebral paralysis as compared to the norm, as well as differences between the groups of patients with varying degree of disorders in gross motor functions. The authors established pathological foot deformities in children with infantile cerebral paralysis; statistically significant variances in types and degrees of these disorders for patient groups with different levels of gross motor functions disorders; distinctiveness of foot deformities within each of the groups. Conclusion. Objectively instrumental method was used to identify the main components of foot deformities in patients with infantile cerebral paralysis with preservation and realization of walking capability: loss of height of longitudinal arches, midfoot pronation and hindfoot valgus, hallux valgus. Increased elevation of longitudinal arches (cavus foot), midfoot supination and hindfoot varus are rarer components of deformities occurring more often in patients with severer forms of the pathology. Strong variation in the spread of foot anatomy parameters observed within different groups of motor dysfunctions indicates the expediency of individual approach to footwear recommendations: standard, less or more complex orthopaedic shoes. Implementation of obtained data into the clinical practice requires additional series of biomechanical trials aimed at elaboration of criteria for recommendations and efficiency evaluation of various footwear types that take into account not only specifics of foot anatomy but also its statodynamic function as well as the level of gross motor functions of a particular patient.