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Surgical treatment of pes planovalgus in ambulatory children with cerebral palsy: Static and dynamic changes as characterized by multi-segment foot modeling, physical examination and radiographs.
Gait Posture. 2020 02; 76:168-174.GP

Abstract

BACKGROUND

This study employs multi-segment foot modeling (MSFM) to examine flatfoot reconstruction among ambulatory children with cerebral palsy (CP).

RESEARCH QUESTION

Does flatfoot reconstruction improve MSFM measures, physical examination and radiographic variables for forefoot varus and midfoot collapse and associated multi-planar compensatory features?

METHODS

MSFM was performed preoperatively and postoperatively in a cohort of ambulatory CP patients undergoing flatfoot reconstruction (surgical group, n = 24). A comparison group of non-surgical group of ambulatory CP patients with pes planovalgus (flatfoot) who did not undergo flatfoot reconstruction was also identified (n = 17). All patients in this comparison group underwent MSFM at two separate time points. Physical examination was performed and standing AP and lateral foot radiographs were obtained during each gait analysis session.

RESULTS

Patients in the surgical group had improvement in their forefoot varus deformity, as documented on physical examination and kinematics in the STJN position of the foot and ankle, as well as in the compensatory hindfoot eversion and midfoot abduction during stance phase of gait. Furthermore, patients in the surgical group had improvement in midfoot collapse as identified kinematically by midfoot dorsiflexion, physical examination descriptors of midfoot position, and radiographic measures of calcaneal pitch and AP and lateral talar-first metatarsal angle. Patients in the non-surgical comparison group did not demonstrate these changes.

SIGNIFICANCE

Improvements in foot motion after flatfoot reconstruction in ambulatory CP patients were identified by MSFM, physical examination measures, and radiographs. Patients in the surgical and non-surgical groups had similar pre-operative radiographic findings, suggesting that physical examination and MSFM data were important in the surgical decision making process. Finally, surgical intervention did not fully restore normal foot kinematic, physical examination, and radiographic parameters, which suggests that a different, perhaps more aggressive, surgical approach for flatfoot reconstruction is needed.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W Grand Blvd Detroit, MI, 48202, USA. Electronic address: nickolas.nahm@gmail.com.Gillete Children's Specialty Healthcare, 200 University Ave East St. Paul, MN, 55101, USA. Electronic address: ssohrweide@gillettechildrens.com.Gillete Children's Specialty Healthcare, 200 University Ave East St. Paul, MN, 55101, USA. Electronic address: rwervey@gillettechildrens.com.Gillete Children's Specialty Healthcare, 200 University Ave East St. Paul, MN, 55101, USA. Electronic address: mschwartz@gillettechildrens.com.Gillete Children's Specialty Healthcare, 200 University Ave East St. Paul, MN, 55101, USA. Electronic address: tnovacheck@gillettechildrens.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31862665

Citation

Nahm, Nickolas J., et al. "Surgical Treatment of Pes Planovalgus in Ambulatory Children With Cerebral Palsy: Static and Dynamic Changes as Characterized By Multi-segment Foot Modeling, Physical Examination and Radiographs." Gait & Posture, vol. 76, 2020, pp. 168-174.
Nahm NJ, Sohrweide SS, Wervey RA, et al. Surgical treatment of pes planovalgus in ambulatory children with cerebral palsy: Static and dynamic changes as characterized by multi-segment foot modeling, physical examination and radiographs. Gait Posture. 2020;76:168-174.
Nahm, N. J., Sohrweide, S. S., Wervey, R. A., Schwartz, M. H., & Novacheck, T. F. (2020). Surgical treatment of pes planovalgus in ambulatory children with cerebral palsy: Static and dynamic changes as characterized by multi-segment foot modeling, physical examination and radiographs. Gait & Posture, 76, 168-174. https://doi.org/10.1016/j.gaitpost.2019.12.004
Nahm NJ, et al. Surgical Treatment of Pes Planovalgus in Ambulatory Children With Cerebral Palsy: Static and Dynamic Changes as Characterized By Multi-segment Foot Modeling, Physical Examination and Radiographs. Gait Posture. 2020;76:168-174. PubMed PMID: 31862665.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical treatment of pes planovalgus in ambulatory children with cerebral palsy: Static and dynamic changes as characterized by multi-segment foot modeling, physical examination and radiographs. AU - Nahm,Nickolas J, AU - Sohrweide,Sue S, AU - Wervey,Roy A, AU - Schwartz,Michael H, AU - Novacheck,Tom F, Y1 - 2019/12/12/ PY - 2019/06/29/received PY - 2019/12/02/revised PY - 2019/12/07/accepted PY - 2019/12/22/pubmed PY - 2020/9/29/medline PY - 2019/12/22/entrez KW - Cerebral palsy KW - Flatfoot KW - Multi-segment foot modeling KW - Pes planovalgus SP - 168 EP - 174 JF - Gait & posture JO - Gait Posture VL - 76 N2 - BACKGROUND: This study employs multi-segment foot modeling (MSFM) to examine flatfoot reconstruction among ambulatory children with cerebral palsy (CP). RESEARCH QUESTION: Does flatfoot reconstruction improve MSFM measures, physical examination and radiographic variables for forefoot varus and midfoot collapse and associated multi-planar compensatory features? METHODS: MSFM was performed preoperatively and postoperatively in a cohort of ambulatory CP patients undergoing flatfoot reconstruction (surgical group, n = 24). A comparison group of non-surgical group of ambulatory CP patients with pes planovalgus (flatfoot) who did not undergo flatfoot reconstruction was also identified (n = 17). All patients in this comparison group underwent MSFM at two separate time points. Physical examination was performed and standing AP and lateral foot radiographs were obtained during each gait analysis session. RESULTS: Patients in the surgical group had improvement in their forefoot varus deformity, as documented on physical examination and kinematics in the STJN position of the foot and ankle, as well as in the compensatory hindfoot eversion and midfoot abduction during stance phase of gait. Furthermore, patients in the surgical group had improvement in midfoot collapse as identified kinematically by midfoot dorsiflexion, physical examination descriptors of midfoot position, and radiographic measures of calcaneal pitch and AP and lateral talar-first metatarsal angle. Patients in the non-surgical comparison group did not demonstrate these changes. SIGNIFICANCE: Improvements in foot motion after flatfoot reconstruction in ambulatory CP patients were identified by MSFM, physical examination measures, and radiographs. Patients in the surgical and non-surgical groups had similar pre-operative radiographic findings, suggesting that physical examination and MSFM data were important in the surgical decision making process. Finally, surgical intervention did not fully restore normal foot kinematic, physical examination, and radiographic parameters, which suggests that a different, perhaps more aggressive, surgical approach for flatfoot reconstruction is needed. SN - 1879-2219 UR - https://www.unboundmedicine.com/medline/citation/31862665/Surgical_treatment_of_pes_planovalgus_in_ambulatory_children_with_cerebral_palsy:_Static_and_dynamic_changes_as_characterized_by_multi_segment_foot_modeling_physical_examination_and_radiographs_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0966-6362(19)31768-0 DB - PRIME DP - Unbound Medicine ER -