Influence of orthopedic shoes on the indicators of the interzonal load distribution on the foot when walking patients with cerebral palsy

Abstract

BACKGROUND: Clinical observations of patients with spastic forms of cerebral palsy and surveys showed the most commonly used technical rehabilitative device of this patient contingent are orthopedic shoes. However, almost no clinical and instrumental studies examine the effect of such shoes on the walking characteristics of patients with cerebral palsy (CP).

AIM: This study aims to estimate the effect of orthopedic shoes on the interzonal load distribution on the plantar foot surface in children with CP and adolescents with different levels of gross motor function disorders (GMFCS).

MATERIALS AND METHODS: Biomechanical studies were conducted in 42 patients with CP 5-16 years old with GMFCS 1–3 level while wearing standard and orthopedic shoes. In 14 healthy children controls while wearing standard shoes (a total of 112 feet). Biomechanical examinations were performed on the software and hardware complex “DiaSled-M-Scan” with matrix plantar pressure meters in the form of insoles. Statistical data analysis was performed using nonparametric methods via SPSS software for Windows.

RESULTS: The use of complex orthopedic shoes in patients with level GMFCS 1 did not improve but worsened their foot loading parameters. The shoes reduced the loading of the heel, increased the toe-heel load ratio, and mediolateral load distribution in the fascicle area. In patients with GMFCS 2, the positive effect of orthopedic shoes was limited to improving the mediolateral load distribution in the fascicle area. In patients with GMFCS 3, the positive effect of orthopedic shoes was noted in the majority of the tested parameters.

CONCLUSION: Thus, the study showed that in children and adolescents with CP using complex orthopedic shoes led to the most significant normalization of interzonal load distribution under the foot in GMFCS 3 patients, less significant — in GMFCS 2 patients, and worsened the parameters in GMFCS 1 patients.

Keywords

rehabilitation / cerebral palsy / GMFCS / orthopedic shoes / biomechanics / walking

References

[1] Armand S, Decoulon G, Bonnefoy-Mazure A. Gait analysis in children with cerebral palsy. EFORT Open Rev. 2016;1:448–460. doi: 10.1302/2058-5241.1.000052

[2] Armand S., Decoulon G., Bonnefoy-Mazure A. Gait analysis in children with cerebral palsy // EFORT Open Rev. 2016. Vol. 1. P. 448–460. doi: 10.1302/2058-5241.1.000052

[3] Valentina J, Davidson SA, Bear N, et al. A prospective study investigating gross motor function of children with cerebral palsy and GMFCS level II after long-term botulinum toxin type A use. BMC Pediatrics. 2020;20(1):7. doi: 10.1186/s12887-019-1906-8

[4] Valentina J., Davidson S.A., Bear N. et al. A prospective study investigating gross motor function of children with cerebral palsy and GMFCS level II after long-term botulinum toxin type A use // BMC Pediatrics. 2020. Vol. 20. No. 1. P. 7. doi: 10.1186/s12887-019-1906-8

[5] Collado-Garrido L, Paras-Bravo P, Calvo-Martin P, Santibanez-Marguello M. Impact of resistance therapy on motor function in children with cerebral palsy: A systematic review and meta-analysis. Int J Environ Res Public Health. 2019;16(22):e4513. doi: 10.3390/ijerph16224513

[6] Collado-Garrido L., Paras-Bravo P., Calvo-Martin P., Santibanez-Marguello M. Impact of resistance therapy on motor function in children with cerebral palsy: A systematic review and meta-analysis // Int. J. Environ. Res. Public Health. 2019. Vol. 16. No. 22. P. e4513. doi: 10.3390/ijerph16224513

[7] Saleh M, Almasri NA, Malkawi SH, Abu-Dahab S. Associations between impairments and activity limitations components of the international classification of functioning and the gross motor function and subtypes of children with cerebral palsy. J Phys Ther Sci. 2019;31(4):299–395. doi: 10.1589/jpts.31.299

[8] Saleh M., Almasri N.A., Malkawi S.H., Abu-Dahab S. Associations between impairments and activity limitations components of the international classification of functioning and the gross motor function and subtypes of children with cerebral palsy // J. Phys. Ther. Sci. 2019. Vol. 31. No. 4. P. 299–395. doi: 10.1589/jpts.31.299

[9] Lee BH. Relationship between gross motor function and the function, activity and participation components of the international classification of functioning in children with spastic cerebral palsy. J Phys Ther Sci. 2017;29(10):1732–1736. doi: 10.1589/jpts.29.1732

[10] Lee B.H. Relationship between gross motor function and the function, activity and participation components of the international classification of functioning in children with spastic cerebral palsy // J. Phys. Ther. Sci. 2017. Vol. 29. No. 10. P. 1732–1736. doi: 10.1589/jpts.29.1732

[11] Son I, Lee D, Hong S, Lee K, Lee G. Comparison of gait ability of a child with cerebral palsy according to the difference of dorsiflexion angle of hinged ankle-foot orthosis: A case report. Am J Case Rep. 2019;20:1454–1459. doi: 10.12659/AJCR.916814

[12] Son I., Lee D., Hong S., Lee K., Lee G. Comparison of gait ability of a child with cerebral palsy according to the difference of dorsiflexion angle of hinged ankle-foot orthosis: A case report // Am. J. Case Rep. 2019. Vol. 20. P. 1454–1459. doi: 10.12659/AJCR.916814

[13] Kim HY, Cha YH, Byun JY, Chun YS, Choy WS. Changes in gait parameters after femoral derotational osteotomy in cerebral palsy patients with medial femoral torsion. Journal of Pediatric Orthopaedics B. 2018;27:194–199. doi: 10.1097/BPB.0000000000000467

[14] Kim H.Y., Cha Y.H., Byun J.Y., Chun Y.S., Choy W.S. Changes in gait parameters after femoral derotational osteotomy in cerebral palsy patients with medial femoral torsion // Journal of Pediatric Orthopaedics B. 2018;27:194–199. doi: 10.1097/BPB.0000000000000467

[15] Patel DR, Neelakantan M, Pandher K, Merrick J. Cerebral palsy in children: a clinical overview. Transl Pediatr. 2020;9(suppl.1):S125–S135. doi: 10.21037/tp.2020.01.01

[16] Patel D.R., Neelakantan M., Pandher K., Merrick J. Cerebral palsy in children: a clinical overview // Transl. Pediatr. 2020. Vol. 9. Suppl. 1. P. S125–S135. doi: 10.21037/tp.2020.01.01

[17] Rasmussen HM, Pederson NW, Overgaard S, et al. Gait analysis for individually tailored interdisciplinary intervention in children with cerebral palsy: a randomized controlled trail. Dev Med Child Neurol. 2019;61(10):1189–1195. doi: 10.1111/dmcn.14178

[18] Rasmussen H.M., Pederson N.W., Overgaard S. et al. Gait analysis for individually tailored interdisciplinary intervention in children with cerebral palsy: a randomized controlled trail // Dev. Med. Child Neurol. 2019. Vol. 61. No. 10. P. 1189–1195. doi: 10.1111/dmcn.14178

[19] Young J, Jackson S. Improved motor function in a pre-ambulatory child with spastic bilateral cerebral palsy, using a custom rigid ankle-foot orthosis-footwear combination: A case report. Prosthet Orthot Int. 2019;43(4):453–458. doi: 10.1177/0309364619852239

[20] Young J., Jackson S. Improved motor function in a pre-ambulatory child with spastic bilateral cerebral palsy, using a custom rigid ankle-foot orthosis-footwear combination: A case report // Prosthet. Orthot. Int. 2019. Vol. 43. No. 4. P. 453–458. doi: 10.1177/0309364619852239

[21] Reis AJ, Schwartz MH. Ground reaction and solid ankle-foot orthoses are equivalent for the correction of crouch gait in children with cerebral palsy. Dev Med Child Neurol. 2019;61(2):219–225. doi: 10.1111/dmcn.13999

[22] Reis A.J., Schwartz M.H. Ground reaction and solid ankle-foot orthoses are equivalent for the correction of crouch gait in children with cerebral palsy // Dev. Med. Child Neurol. 2019. Vol. 61. No. 2. P. 219–225. doi: 10.1111/dmcn.13999

[23] Schwarze M, Block J, Kunz T, et al. The added value of orthotic management in the context of multi-level surgery in children with cerebral palsy. Gait Posture. 2019;68:525–530. doi: 10.1016/j.gaitpost.2019.01.006

[24] Schwarze M. Block J. Kunz T. et al. The added value of orthotic management in the context of multi-level surgery in children with cerebral palsy // Gait Posture. 2019. Vol. 68. P. 525–530. doi: 10.1016/j.gaitpost.2019.01.006

[25] Dzhomardly EI, Koltsov AA. Analysis of the use of technical means for rehabilitation of patients with spastic types of cerebral palsy depending on the level of patient’ motor function. Genij ortopedii. 2020;26(1):57–64. doi: 10.18019/1028-4427-2020-26-1-57-64. (In Russ.)

[26] Джомардлы Э.И., Кольцов А.А. Анализ использования технических средств реабилитации у пациентов со спастическими формами детского церебрального паралича в зависимости от уровня глобальных моторных функций пациента // Гений ортопедии. 2020. Vol. 26. No. 1. P. 57–64. doi: 10.18019/1028-4427-2020-26-1-57-64

[27] Meyns P, Kerkum YL, Brehm MA, et al. Ankle foot orthoses in cerebral palsy: Effects of ankle stiffness on trunk kinematics, gait stability and energy cost of walking. Eur J Paediatr Neurol. 2020;26:68–74. doi: 10.1016/j.ejpn.2020.02.009

[28] Meyns P., Kerkum Y.L., Brehm M.A. et al. Ankle foot orthoses in cerebral palsy: Effects of ankle stiffness on trunk kinematics, gait stability and energy cost of walking // Eur. J. Paediatr. Neurol. 2020. Vol. 26. P. 68–74. doi: 10.1016/j.ejpn.2020.02.009

[29] Wright E, DiBello SA. Principles of ankle-foot orthosis prescription in ambulatory bilateral cerebral palsy. Phys. Med. Rehabil. Clin. N. Am. 2020;31(1):69–89. doi: 10.1016/j.pmr.2019.09.007

[30] Wright E., DiBello S.A. Principles of ankle-foot orthosis prescription in ambulatory bilateral cerebral palsy // Phys. Med. Rehabil. Clin. N. Am. 2020. Vol. 31. No. 1. P. 69–89. doi: 10.1016/j.pmr.2019.09.007

[31] Aboutorabi A, Arazpour M, Ahmadi Bani M, et al. Efficacy of ankle foot orthoses types on walking in children with cerebral palsy: A systematic review. Ann. Phys. Rehabil. Med. 2017;60(6): 393–402. doi: 10.1016/j.rehab.2017.05.004

[32] Aboutorabi A., Arazpour M., Ahmadi Bani M. et al. Efficacy of ankle foot orthoses types on walking in children with cerebral palsy: A systematic review // Ann. Phys. Rehabil. Med. 2017. Vol. 60. No. 6. P. 393–402. doi: 10.1016/j.rehab.2017.05.004

[33] Murri A, Zechner G. Corrective dynamic shoe fitting of the functional clubfoot in patients with infantile cerebral palsy. Z. Orthop. Ihre. Grenzgeb. 1994;132(3):214–220. (In German)

[34] Murri A., Zechner G. Corrective dynamic shoe fitting of the functional clubfoot in patients with infantile cerebral palsy // Z. Orthop. Ihre. Grenzgeb. 1994. Vol. 132. No. 3. P. 214–220. (In German)

[35] Bekk NV, Belova LA, Lapina TS. Feature customization of orthopedic shoes for children with cerebral palsy. ISJ Theoretical and Applied Science. 2018;12(68):117–121. doi: 10.15863/TAS.2018.12.68.21

[36] Bekk N.V., Belova L.A., Lapina T.S. Feature customization of orthopedic shoes for children with cerebral palsy // ISJ Theoretical and Applied Science. 2018. Vol. 12. No. 68. P. 117–121. doi: 10.15863/TAS.2018.12.68.21

[37] Uzakova LP, Mukhammedova MO. Technological solution construction of orthopedic shoes considering biometherics of lower extremities. World science: Problems and Innovation. Penza: Nauka i Prosveshhenie; 2018. P. 47–51. (In Russ.)

[38] Узакова Л.П., Мухаммедова М.О. Технологическое решение конструирования ортопедической обуви, учитывая биомеханику нижних конечностей // World science: Problems and Innovation. Пенза: Наука и Просвещение, 2018. С. 47–51.

[39] Palisano R, Rosenbaum P, Walter S, et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214–223. doi: 10.1111/j.1469-8749.1997.tb07414.x

[40] Palisano R., Rosenbaum P., Walter S. et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy // Dev. Med. Child Neurol. 1997. Vol. 39. No. 4. P. 214–223. doi: 10.1111/j.1469-8749.1997.tb07414.x

[41] Smirnova LM. Hardware-Software complex for assessment of anatomic-functional disturbances and orthosis efficiency in patients with foot pathology. Biomedical Engineering. 2009;43(6):260–264. doi: 10.1007/s10527-010-9137-1. (In Russ.)

[42] Смирнова Л.М. Программно-аппаратный комплекс для оценки анатомо-функциональных нарушений и эффективности ортезирования при патологии стопы // Медицинская техника. 2009. Vol. 6. P. 22–26. doi: 10.1007/s10527-010-9137-1

[43] Sees JP, Miller F. Overview of foot deformity management in children with cerebral palsy. J Child Orthop. 2013;7:373–377. doi: 10.1007/s11832-013-0509-4

[44] Sees J.P., Miller F. Overview of foot deformity management in children with cerebral palsy // J. Child Orthop. 2013. Vol. 7. P. 373–377. doi: 10.1007/s11832-013-0509-4

[45] Silfverskoild N. Reduction of the uncrossed two-joints muscles of the leg to one-joint muscles in spastic condition. Acta Chir Scand. 1924;56:315–328.

[46] Silfverskoild N. Reduction of the uncrossed two-joints muscles of the leg to one-joint muscles in spastic condition // Acta Chir. Scand. 1924. Vol. 56. P. 315–328.

[47] Mosca VS. Flexible flatfoot in children and adolescents. J. Child. Orthop. 2010;4(2):107–121. doi: 10.1007/s11832-010-0239-9

[48] Mosca V.S. Flexible flatfoot in children and adolescents // J. Child Orthop. 2010. Vol. 4. No. 2. P. 107–121. doi: 10.1007/s11832-010-0239-9

[49] Falisse A, Pitto L, Kainz H, et al., Physics-based stimulations to predict the differential effects of motor control and musculoskeletal deficits on gait dysfunction in children cerebral palsy: A retrospective case study. Front Hum Neurosci. 2020;14:40. doi: 10.3389/fnhum.2020.00040

[50] Falisse A., Pitto L., Kainz H. et al. Physics-based stimulations to predict the differential effects of motor control and musculoskeletal deficits on gait dysfunction in children cerebral palsy: A retrospective case study // Front. Hum. Neurosci. 2020. Vol. 14. P. 40. doi: 10.3389/fnhum.2020.00040

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Smirnova L.M., Koltsov A.A., Dzhomardly E.I.