Biomechanical gait parameters in children with unilateral and bilateral clubfoot

Abstract A variety of congenital pediatric disorders have demonstrated that foot deformities interfere in locomotion ability. However, there are uncertainties about the mechanical effects of this deformity. Quantitative gait analysis allows the measurement and assessment of walking biomechanics, which facilitates the recommendation of treatment alternatives. The purpose of this investigation was to analyze gait parameters in unilateral and bilateral clubfoot children after operative therapy. Observational Original Scientific Article. The protocol consisted of self-selected speed gait investigation with parameter identification in vertical and antero-posterior ground reaction forces and ankle and knee angles. Non-parametric statistics tests were used in analysis of the results. Children with clubfoot showed larger imbalances in parameters with an emphasis towards the greatest differences occurring between unilateral clubfoot group and controls. For initial stance phase, we found higher first vertical force peak and knee and ankle angular alterations. For midstance, we observed more knee flexion and ankle dorsiflexion, and less vertical force. For propulsion phase, there were smaller values in antero-posterior force, second vertical force peak and plantarflexion. Unilateral clubfoot presents more imbalances in gait biomechanical parameters compared with bilateral clubfoot children. The alterations in gait parameters in this study help to understand the imbalances and provide information to understand the lower extremity movements during gait in clubfoot children.

摘要 多种先天性儿科疾病均证实，足部畸形会对运动能力产生不良影响。然而，这类畸形所带来的力学效应仍存在诸多不确定性。定量步态分析可实现行走生物力学的量化测量与评估，可为治疗方案的推荐提供有力支撑。本研究旨在分析手术治疗后单侧与双侧马蹄足（clubfoot）儿童的步态参数。本研究属于观察性原创科学论文。实验方案采用自选步速开展步态测试，对垂直及前后向地面反作用力、踝关节与膝关节角度进行参数识别。数据分析采用非参数统计检验方法。结果表明，马蹄足儿童的步态参数存在更显著的失衡情况，其中以单侧马蹄足组与健康对照组间的差异最为突出。在站立初始阶段，受试者的第一垂直力峰值更高，膝关节与踝关节角度出现异常变化；在站立中期，可见膝关节屈曲度与踝关节背屈度更高，而垂直反作用力更低；在推进阶段，前后向地面反作用力、第二垂直力峰值及踝关节跖屈值均更小。相较于双侧马蹄足儿童，单侧马蹄足患儿的步态生物力学参数失衡情况更为明显。本研究中观测到的步态参数变化，有助于深入理解马蹄足儿童步态中的失衡状态，并为解析其行走过程中下肢运动模式提供参考依据。