Abstract：
Foot deformities (e.g. planovalgus and cavovarus) are very common in children with spastic cerebral palsy (CP), with the midfoot often being involved. Dynamic foot function can be assessed with 3D gait analysis including a multi-segment foot model. Incorporating a midfoot segment in such a model, allows quantification of separate Chopart and Lisfranc joint kinematics. Yet, midfoot kinematics have not previously been reported in CP.
What is the difference in multi-segment kinematics including midfoot joints between common foot deformities in CP and typically-developing feet?
103 feet of 57 children with spastic CP and related conditions were retrospectively included and compared with 15 typically-developing children. All children underwent clinical gait analysis with the Amsterdam Foot Model marker set. Multi-segment foot kinematics were calculated for three strides per foot and averaged. A k-means cluster analysis was performed to identify foot deformity groups that were present within CP data. The deformity type represented by each cluster was based on the foot posture index. Kinematic output of the clusters was compared to typically-developing data for a static standing trial and for the range of motion and kinematic waveforms during walking, using regular and SPM independent t-tests respectively.
A neutral, planovalgus and varus cluster were identified. Neutral feet showed mostly similar kinematics as typically-developing data. Planovalgus feet showed increased ankle valgus and Chopart dorsiflexion, eversion and abduction. Varus feet showed increased ankle varus and Chopart inversion and adduction.
This study is the first to describe Chopart and Lisfranc joint kinematics in different foot deformities of children with CP. It shows that adding a midfoot segment can provide additional clinical and kinematic information. It highlights joint angles that are more distinctive between deformities, which could be helpful to optimize the use of multi-segment foot kinematics in the clinical decision making process.
What is the difference in multi-segment kinematics including midfoot joints between common foot deformities in CP and typically-developing feet?
103 feet of 57 children with spastic CP and related conditions were retrospectively included and compared with 15 typically-developing children. All children underwent clinical gait analysis with the Amsterdam Foot Model marker set. Multi-segment foot kinematics were calculated for three strides per foot and averaged. A k-means cluster analysis was performed to identify foot deformity groups that were present within CP data. The deformity type represented by each cluster was based on the foot posture index. Kinematic output of the clusters was compared to typically-developing data for a static standing trial and for the range of motion and kinematic waveforms during walking, using regular and SPM independent t-tests respectively.
A neutral, planovalgus and varus cluster were identified. Neutral feet showed mostly similar kinematics as typically-developing data. Planovalgus feet showed increased ankle valgus and Chopart dorsiflexion, eversion and abduction. Varus feet showed increased ankle varus and Chopart inversion and adduction.
This study is the first to describe Chopart and Lisfranc joint kinematics in different foot deformities of children with CP. It shows that adding a midfoot segment can provide additional clinical and kinematic information. It highlights joint angles that are more distinctive between deformities, which could be helpful to optimize the use of multi-segment foot kinematics in the clinical decision making process.
摘要：
背景：足部畸形（例如，平面外翻和腹壁外翻）在患有痉挛型脑瘫（CP）的儿童中非常常见，中脚经常参与其中。动态足部功能可以用包括多段足部模型的3D步态分析来评估。在这样的模型中加入一个中足部分，允许量化单独的Chopart和Lisfranc关节运动学。然而，在CP中以前没有报道过中足运动学。
目的：在包括足中关节在内的多节运动学方面，CP中常见的足畸形和典型发育的足之间有什么不同？
方法：回顾性纳入57例痉挛型CP及相关疾病儿童的103英尺，并与15例典型发育儿童进行比较。所有儿童均使用阿姆斯特丹脚模型标记集进行临床步态分析。计算每英尺三步的多段脚运动学并进行平均。进行了k均值聚类分析，以识别CP数据中存在的足部畸形组。每个聚类表示的畸形类型基于足部姿势指数。将集群的运动学输出与静态站立试验以及步行过程中的运动范围和运动学波形的典型发展数据进行比较，分别采用常规t检验和SPM独立t检验。
结果：中性，确定了平面圆和内翻簇。中性脚的运动学与通常的数据相似。足外翻显示踝关节外翻和肖帕特背屈增加，外翻和绑架。内翻足显示踝内翻增加，肖帕特内翻和内收增加。
结论：这项研究首次描述了CP患儿不同足部畸形的Chopart和Lisfranc关节运动学。它表明，添加足中部段可以提供额外的临床和运动学信息。它突出了畸形之间更独特的关节角度，这可能有助于优化多段足部运动学在临床决策过程中的使用。
目的：在包括足中关节在内的多节运动学方面，CP中常见的足畸形和典型发育的足之间有什么不同？
方法：回顾性纳入57例痉挛型CP及相关疾病儿童的103英尺，并与15例典型发育儿童进行比较。所有儿童均使用阿姆斯特丹脚模型标记集进行临床步态分析。计算每英尺三步的多段脚运动学并进行平均。进行了k均值聚类分析，以识别CP数据中存在的足部畸形组。每个聚类表示的畸形类型基于足部姿势指数。将集群的运动学输出与静态站立试验以及步行过程中的运动范围和运动学波形的典型发展数据进行比较，分别采用常规t检验和SPM独立t检验。
结果：中性，确定了平面圆和内翻簇。中性脚的运动学与通常的数据相似。足外翻显示踝关节外翻和肖帕特背屈增加，外翻和绑架。内翻足显示踝内翻增加，肖帕特内翻和内收增加。
结论：这项研究首次描述了CP患儿不同足部畸形的Chopart和Lisfranc关节运动学。它表明，添加足中部段可以提供额外的临床和运动学信息。它突出了畸形之间更独特的关节角度，这可能有助于优化多段足部运动学在临床决策过程中的使用。
