Dynamic Foot-Pressure Measurement In The Assessment Of Operatively Treated Clubfeet

Objective:Congenital clubfoot is a common congenital malformation in children, the incidence rate of about 1‰, twice as many boys as girls, unilateral than bilateral, forefoot deformities including adduction, heel varus, ankle Horseshoe joint and combined internal rotation of the tibia.Diverse of treatment ,multi-effect assessment is based on foot shape and gait ,lack of uniform and objective indicators. Therefore, there are different reports of the congenital clubfoot treatment efficacy. Based on this, this study applies FootscanUSB2 flat foot pressure analysis system, combined with the traditional measurement of physical measurements and radiological parameters of children with congenital clubfoot evaluation. Clear dynamic plantar pressure distribution of children with congenital clubfoot and measure changes in these parameters after surgery to assess the function of the affected foot after surgery to provide a theoretical basis for the clinical.Methods:Admitted from 1996 to 2010, soft tissue surgery, and a return visit of 70 patients (103 feet) with congenital clubfoot were studied retrospectively.Group A: To 1996.10-2008.12 hospitalized patients, 26 male and 38-foot (8 patients with left foot, right foot in 6 cases, 12 cases of feet) and 16 females, 24-foot (left foot in 5 cases, 3 cases of right foot, 8 cases of feet), A total of 42 cases of 62 feet. Age of 5 years -21 years (mean 11.6 years). By Dimeglio type:Ⅱ-type 12 patients (17 feet),Ⅲtype 25 patients (37 feet),Ⅳtype in 5 cases (8 feet). This group of patients only has operated plantar pressure parameters, contrast with the same height, same weight of normal children.Group B: To 2008.12-2010.9 admitted patients, 12 males and 20-foot (left foot in 2 cases, 2 cases of right foot, 8 cases of feet) and 16 females, 21-foot (left foot in 7 cases, 4 cases of right foot, 5 cases of feet), A total of 28 cases of 41 feet. Age 2 years and 8 months -14 years (mean 6.4 years). By Dimeglio type:Ⅱtype 5 (9 feet),Ⅲtype 20 cases (27 feet),Ⅳtype 3 (5 feet). The group has parameters of plantar pressure before and after surgery.We apply the treatment that extended by the Achilles tendon, tibialis anterior muscle tendon surgery, some typeⅣpatients plus medial soft tissue release surgery.The visit of the patients are applied with plantar pressure foot gait analysis system made by Footscan companies of Belgian for biomechanical analysis. Subjects of barefoot walk in the natural force plate, the entire testing process without crying and discomfort, as usual walking, walking back and forth 4-5 times normal, the data collected by computer analysis system.At the same time the return visit patients are scored according to HuangYT foot function standard, and the results of scoring and dynamic plantar pressure parameters were statistically analyzed by SPSS13.0 statistical software. All data is described by mean±standard, the same group compared with paired t test, comparison between groups using independent sample t test, P value <0.05 was considered statistically significant. Using Spearman rank correlation test, analysis the correlation between the plantar pressure data and HuangYT score.in the stance phase process.Results:1 Group A follow-up of 6.8 years meanly and the shortest 4 years, up to 12 years and 2 months. The preoperative HuangYT score is 59.16±8.03, postoperation 88.25±8.25, excellent in 32 cases, good in 6 cases and 2 cases and poor in 2 cases, good rate of 90.48%; B follow up of 2.6 years meanly and the shortest 2 years, the longest 4 years and 3 months. The preoperative HuangYT score 61.72±7.16, postoperation 86.79±6.24, excellent in 21 cases, good in 5 cases, 1 case and poor in 1 case, good rate of 92.86%. Score differences of the HuangYT in both groups of pre and post operation were statistically significant ( P <0.05). 2 Visit patients compared with control group, there are no significant difference of the peak plantar pressure and the contact area.of each region.3 compared with preopreation in group B, first toe, the peak pressure of first metatarsal, second metatarsal, medial heel, lateral heel region are less than that of postoperation.The peak pressure of the 2-5 toe and the 4,5 metatarsal are greater than that of postoperation. The contact area of the first toe,the first metatarsal, midfoot, and medial heel region is less than postoperation.4 A, B of postoperation dynamic plantar peak pressure are in the second metatarsal region.5 Peak plantar pressure and contact area of second metatarsal head, medial heel, lateral heel and HuangYT score was highly correlated.Conclusion:1 Dynamic plantar pressure measurement can dynamically evaluate postoperative functional of congenital clubfoot2 Dynamic plantar pressure measurement can be repetitive, and fully understand the extent of postoperative residual deformityis .It is an objective assessment method of the efficacy of clubfoot and can be used to guide further treatment and rehabilitation.