Longitudinal change in foot posture in children with cerebral palsy

Area of Science:

• Pediatric Orthopedics
• Neurology
• Biomechanical Engineering

Background:

• Foot deformities are prevalent in children with cerebral palsy (CP).
• The developmental trajectory of these foot deformities throughout childhood growth is not well-documented.
• Understanding foot posture changes is crucial for effective management strategies.

Purpose of the Study:

• To prospectively observe and analyze the changes in foot posture during growth in children with cerebral palsy (CP).
• To compare foot posture evolution between different Gross Motor Function Classification Scale (GMFCS) levels and typically developing (TD) children.
• To investigate the impact of CP on coronal plane foot alignment and pressure distribution over time.

Main Methods:

• Prospective longitudinal study of 51 children with CP (aged 2-12 years), categorized by GMFCS levels (I/IV and III/IV).
• Exclusion of data post-bony foot correction surgeries.
• Outcome measures included Coronal Plane Pressure Index (CPPI) and pressure impulses (heel, medial midfoot, medial forefoot), analyzed using LOESS smoothing and FANOVA.

Main Results:

• Children with GMFCS I/II exhibited more foot valgus than TD children until age seven, after which it normalized.
• Children with GMFCS III/IV consistently showed increased foot valgus compared to TD children throughout the study period (2-12 years).
• Both GMFCS groups had significantly reduced heel impulse compared to TD children, with GMFCS III/IV showing less heel contact than GMFCS I/II.

Conclusions:

• Early variability and tendency for valgus foot posture resolution in CP children suggest conservative management for coronal plane deformities in early childhood.
• This approach is particularly recommended for children classified as GMFCS I and II.
• Reduced heel impulse and altered heel contact in CP children indicate potential biomechanical differences impacting gait.