Elevated plantar foot pressures during gait in diabetic patients with neuropathy have been suggested to result, among other factors, from the distal displacement of sub-metatarsal head (MTH) fat-pad cushions caused by to claw/hammer toe deformity. The purpose of this study was to quantitatively assess these associations. Thirteen neuropathic diabetic subjects with claw/hammer toe deformity, and 13 age- and gender-matched neuropathic diabetic controls without deformity, were examined. Dynamic barefoot plantar pressures were measured with an EMED pressure platform. Peak pressure and force-time integral for each of 11 foot regions were calculated. Degree of toe deformity and the ratio of sub-MTH to sub-phalangeal fat-pad thickness (indicating fat-pad displacement) were measured from sagittal plane magnetic resonance images of the foot. Peak pressures at the MTHs were significantly higher in the patients with toe deformity (mean 626 (SD 260) kPa) when compared with controls (mean 363 (SD 115) kPa, Po0.005). MTH peak pressure was significantly correlated with degree of toe deformity (r= 0.74) and with fat-pad displacement (r= 0.71) (Po0.001). The ratio of force-time integral in the toes and the MTHs (toe-loading index) was significantly lower in the group with deformity. These results show that claw/hammer toe deformity is associated with a distal-to-proximal transfer of load in the forefoot and elevated plantar pressures at the MTHs in neuropathic diabetic patients. Distal displacement of the plantar fat pad is suggested to be the underlying mechanism in this association. These conditions increase the risk for plantar ulceration in these patients.
DOCUMENT
A clubfoot is characterized by a three-dimensional deformity with an equinus, varus, cavus and adduction component. Nowadays the Ponseti method is the preferred treatment for clubfeet, aiming to achieve a normal appearing, functional and painless foot. The reoccurrence of clubfoot components in treated clubfeet, a relapse, is a known problem in clubfoot patients. 3Dgait analysis can be used in assessment of foot function and residual deviations in gait or possible relapses. Gait analysis is frequently used to analyse differences in gait between clubfoot and healthy controls. However, the usage of multisegment foot models is, although of importance considering the characteristics of the clubfoot, rare. In order to capture the full multi-planar and multi-joint nature of a clubfoot, it is highly important to implement multi-segment foot models in gait analysis. In order to improve treatment of individual relapse clubfoot kinematics differences in clinical relevant functional outcomes should be known.
DOCUMENT
This study aims to identify kinematic differences between children with Ponseti treated clubfoot and age-mat- ched healthy controls during gait, using the Oxford Foot Model. This pilot is part of a large project comparing gait kinematics between children with Ponseti treated clubfoot with and without relapse and healthy controls. Final results could identify relevant gait parameters which will allow for early detection of a relapse clubfoot.
DOCUMENT
The clubfoot deformity is one of the most common congenital orthopaedic “conditions”. Worldwide approximately 100,000 children are born with unilateral or bilateral clubfoot every year. In the Netherlands the incidence is approximately 175 every year. This three dimensional deformity of the foot involves, equinus, varus, adductus, and cavus . Left untreated the clubfoot leads to deformity, functional disability and pain. Physical impairments of children with clubfoot might lead to limitations in activities and therefore impede a child’s participation. In clinical practice, the orthopaedic surgeon and physiotherapists are regularly consulted by (parents of) clubfoot patients for functional problems such as impaired walking and other daily activities. This does not only affect long-term and physical health of a child, it will also affect the development of social relationships and skills as well. Since walking is a main activity in children to be able to participate in daily life, our previous study (financially supported by SIA Raak Publiek) focussed on gait differences between children with clubfoot and controls. However, differences in gait characteristics do not necessarily lead to functional limitations and restricted participation. Therefore, providing insight in participation and a child’s performance in other activities than walking is necessary. Insight in a child’s participation will also indicate the functional outcome of the treatment, which on its turn could provide essential information concerning a possible relapse.. Early identification of a relapse is important since it could prevent the need for major surgical interventions. The occurrence of a relapse clubfoot will probably also lead to functional differences in the foot as well as problems during activity and participation. Therefore, the main focus of this study is the functional outcomes of physical activities and the characterisation of participation of children with clubfeet in daily activities of childhood.
