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Updated: Jun 29, 2025
Evaluating the Function of the Foot Core System in the Elderly
Published on: March 11, 2022
Reconsidering the Gold Standard for the Assessment of Spastic Equinus Foot
Axel Horsch1, Saskia Kleiber, Maher Ghandour
1From the Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany. (Dr. Horsch, Dr. Kleiber, Dr. Ghandour, Dr. Deisenhofer, and Dr. Putz); Department Orthopedics and Trauma Surgery, Marienkrankenhaus Soest, Soest, Germany (Dr. Klotz); Department of Orthopaedics and Traumatology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany (Dr. Klotz).
Introduction:
To determine whether differences exist in the measured range of motion (ROM) by the goniometer, equinometer, and 3-dimensional (3D) gait analysis in different settings (under general anesthesia (GA) or in the clinic) among patients with cerebral palsy.
Methods:
A prospective comparative cohort study was conducted at our orthopaedics center, where 15 patients with diplegic cerebral palsy (30 limbs) were evaluated, all of whom had Gross Motor Function Classification System (GMFCS) level I and II. ROM was measured by (1) goniometer under GA (benchmark), (2) goniometer analysis during clinical examination, (3) equinometer under GA, (4) equinometer in the clinic, and (5) 3D gait analysis. ROM was measured during both knee flexion and extension. Subgroup analysis based on the GMFCS level was performed.
Results:
Nine patients were male with GMFCS level I and a mean age of 14.3 (SD=7.2) years. Statistically significant differences were noted between all studied measurement techniques in terms of ROM, dorsiflexion, and plantarflexion during both knee flexion and extension. The GMFCS level was an effect modifier of ROM measurements.
Discussion:
The ROM parameters during both knee flexion and extension differed from one measurement device/technique to another. The GMFCS level played a notable effect-modifying role on the ROM parameters.
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