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Longitudinal Change in Foot Posture in Children with Cerebral Palsy

by MASS4D® Prescription Orthotics October 18, 2017


The purpose of this study was to identify unique trends in the development of foot deformity using dynamic foot pressure data in children with cerebral palsy (CP) from early walking to adolescence.

Children aged 17 to 40 months with primarily spastic CP were recruited to participate in this IRB-approved prospective longitudinal observational study.

All children involved in this study were treated by orthopaedic surgeons from a single centre that specialises in the management of CP.

The centre follows a treatment philosophy in which children receive physical therapy during early childhood: children are regularly braced if foot or ankle deformity is present.

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Therapy, bracing, Botox and soft-tissue surgery were delivered to participants in this study as part of this standard clinical care.

Surgery to correct varus or valgus foot deformity including bony foot surgery, tibialis anterior or tibialis posterior tendon transfer or lengthening were exclusion criteria for the analysis.

The children included in this study were examined every six months until they were aged five years.

When they were aged four to eight years, children were classified according to the Gross Motor Function Classification Scale (GMFCS).

During each visit, three footstrikes on each side were collected with the pedobarograph, and average values were used for analysis; children walked barefoot, independently, with their typical assistive device, or were hand-held.

From the pedobarograph, the foot was divided into five areas—the heel, the lateral forefoot (LLF), the medial forefoot (MFF), the lateral midfoot (LMF) and the medial midfoot (MMF).

The coronal plane pressure index (CPPI) was used as a single objective measure to evaluate the overall distribution foot pressure.

Children with CP demonstrated significantly greater valgus compared with typically developing (TD) children until the age of seven years.

Due to early variability and the tendency for resolving valgus foot posture in children with CP, conservative management of coronal plane foot deformity is suggested in early childhood, especially for children classified as GMFCS I and II.

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  1. Church, C., Lennon, N., Alton, R., Schwartz, J., Niiler, T., Henley, J., Miller, F. (2017) Longitudinal Change in Foot Posture in Children with Cerebral Palsy. Journal of Children’s Orthopaedics: 2017, Vol. 11, pp. 229-236.

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