Assessment of gait characteristics and orthotic management in children with Developmental Coordination Disorder: Preliminary findings to inform multidisciplinary care

Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder characterised by impaired motor co-ordination and awkward gait. Despite self-reported findings of pes planus and joint hypermobility in children with DCD, there is little objective evidence regarding the clinical management of the foot in children with DCD. The aims of this research were to report clinical findings of foot posture and lower limb hypermobility in children with DCD and to evaluate the impact of foot orthoses on spatio-temporal gait parameters. Children with DCD were recruited into the study. Participants were randomly assigned to an intervention group who received foot orthoses at the start of their rehabilitation programme or to a second group who received foot orthoses at the end of their intervention programme. Foot posture was assessed with the Foot Posture Index and lower limb hypermobility assessed with the Lower Limb Assessment Score. The effect of foot orthoses was evaluated through assessment of spatio-temporal gait characteristics at baseline and post-rehabilitation programme. Fourteen children were recruited (mdn age 7.5 years) with nine children assigned to the group receiving orthoses early (mdn age 8 years) and five children assigned to the post-rehabilitation orthoses group (mdn age 6.5 years). A pes planus foot posture (FPI score = 8) and lower limb hypermobility (LLAS score = 11) were observed. Changes in spatio-temporal gait parameters failed to reach significance (p > .012) following orthotic invention but demonstrated a trend towards a decreased cadence and increased double support duration. Despite non-significant findings this work offers preliminary support for podiatric intervention in the rehabilitation of children with DCD. Further work is required to understand the biomechanics of gait in children with DCD and appreciate the role of podiatry as a component of multidisciplinary care.     

Foot pronation during walking is associated to the mechanical resistance of the midfoot joint complex

BackgroundThe demonstration of the relationship between midfoot passive mechanical resistance and foot pronation during gait may guide the development of assessment and intervention methods to modify foot motion during gait and to alter midfoot passive mechanical resistance.Research questionIs foot pronation during the stance phase of gait related to the midfoot passive mechanical resistance to inversion?MethodsThe resistance torque and stiffness provided by midfoot soft tissues of 33 participants (21 females and 12 males) with average of 26.21 years were measured. In addition, the participants’ forefoot and rearfoot kinematic data during the stance phase of gait were collected with the Qualisys System (Oqus 7+). Correlation Coefficients were calculated to test the association between kinematic variables representing pronation (forefoot-rearfoot inversion, forefoot-rearfoot dorsiflexion and rearfoot-shank eversion) and maximum resistance torque and maximum stiffness of the midfoot with α = 0.05.ResultsReduced maximum midfoot resistance torque was moderately associated with increased forefoot-rearfoot inversion peak (p = 0.029; r = 0.38), with forefoot-rearfoot dorsiflexion peak (p = 0.048; r = −0.35) and with rearfoot-shank eversion peak (p = 0.008; r = −0.45). Maximum midfoot stiffness was not associated to foot pronation.SignificanceThe smaller the midfoot resistance torque, the greater the forefoot-rearfoot inversion and dorsiflexion peaks and the rearfoot-shank eversion peak during gait. The findings suggest the existence of a relationship between foot pronation and midfoot passive mechanical resistance. Thus, changes in midfoot passive mechanical resistance may affect foot pronation during gait.     

Lower-leg Kinesio tape reduces rate of loading in participants with medial tibial stress syndrome

ContextMedial tibial stress syndrome (MTSS) is an overuse injury occurring among the physically active. Linked to increased strain on the medial tendons of the ankle, studies emphasize controlling medial foot loading in the management of this condition. Kinesio taping (KT) has gained popularity for treating musculoskeletal pathologies; however, its effect on MTSS remains uninvestigated. This study aimed to determine if healthy participants and patients with current or previous history of MTSS differ in the rate of loading, and if KT affects plantar pressures in these participants.MethodsTwenty healthy participants and 20 participants with current or previous history of MTSS were recruited and walked across a plantar pressure mat prior to KT application, immediately after application, and after 24-h of continued use. Time-to-peak force was measured in 6 foot areas and compared across groups and conditions.ResultsANOVA revealed a significant interaction between group, condition, and foot area (F = 1.990, p = 0.033). MTSS participants presented with lower medial midfoot time-to-peak force before tape application (95%CI: 0.014–0.160%, p = 0.021) that significantly increased following tape application (p < 0.05).ConclusionsThese results suggest that KT decreases the rate of medial loading in MTSS patients. Future research might assess mechanisms by which this effect is achieved.     

Plantar loading changes with alterations in foot strike patterns during a single session in habitual rear foot strike female runners

ObjectivesCharacterize plantar loading parameters when habitually rear foot strike (RFS) runners change their pattern to a non-rear foot strike (NRFS).DesignExperimental.SettingUniversity biomechanics laboratory.ParticipantsTwenty three healthy female runners (Age: 22.17 ± 1.64 yrs; Height: 168.91 ± 5.46 cm; Mass: 64.29 ± 7.11 kg).Main outcome measuresPlantar loading was measured using an in-sole pressure sensor while running down a 20-m runway restricted to a range of 3.52–3.89 m/s under two conditions, using the runner's typical RFS, and an adapted NRFS pattern. Repeated measures multivariate analysis of variance was performed to detect differences in loading between these two conditions.ResultsForce and pressure variables were greater in the forefoot and phalanx in NRFS and greater in the heel and mid foot in RFS pattern, but the total force imposed upon the whole foot and contact time remained similar between conditions. Total peak pressure was higher and contact area was lower during NRFS running.ConclusionsThe primary finding of this investigation is that there are distinctly different plantar loads when changing from a RFS to NRFS during running. So, during a transition from RFS to a NRFS pattern; a period of acclimation should be considered to allow for adaptations to these novel loads incurred on plantar regions of the foot.     

Outcomes in chevron osteotomy for Hallux Valgus in a large cohort

Clinical and radiological related outcomes have been reported for Chevron osteotomy as correction for mild to moderate hallux valgus, but only for relatively small patient series. Moreover, evaluation of the patient’s point of view has mostly been conducted by means of more physician-based outcome measures. The goal of this study was to evaluate the effect of the Chevron osteotomy for hallux valgus on patients’ daily lives using the Foot and Ankle Outcome Score (FAOS) as a validated and a hallux valgus specific patient reported outcome measure (PROM). Secondary outcome measures were radiological correction, complication rate, and re-operations.All 438 Chevron procedures (336 patients), at two surgical hospital sites in the period between January 2010 and October 2014, were retrospectively evaluated with a follow-up of at least 6 months. Patients were invited to fill in a cross-sectional online FAOS.For the FAOS, a total response of 60% was achieved. The FAOS ranged between 71 and 88 with a follow-up of on average 36 months. Patients with an undercorrection of their hallux valgus (11.6% of the procedures) scored significantly lower on three subscales of the FAOS (range between 61 and 77 versus 72–84). Patients who had a reoperation (12.6% of the procedures) also scored significantly lower on four subscales: 58–100 versus 73–89. Postoperative radiological measurements improved significantly with a mean difference of 6.1 (5.9; 6.4) degrees for the intermetatarsal angle and 13.7 (13.0; 14.5) degrees for the hallux valgus angle.In this large study cohort, Chevron osteotomy for hallux valgus offers good PROM scores on FAOS. These scores were significantly lower in patients with radiological undercorrection or with a reoperation. Results of the FAOS appear to modulate with physician based outcomes and therapeutic incidents. Improvement of outcome may therefore well be possible by increased attention on these surgical details.     

Stance and sensory feedback influence on postural dynamics

This study examined the effects of ice-induced plantar desensitization and the withdrawal of visual feedback on the magnitude and time-dependent structure of postural sway variability. The magnitude of variability was quantified as the area of an ellipse enclosing 95% of the center of pressure (COP) time-series during normal and tandem stances. The same time-series were also analyzed using Approximate Entropy (ApEn) and Cross-Approximate Entropy (CrossApEn) as indices of irregularity and asynchrony between the mediolateral and anteroposterior COP motions. Variability increased during tandem stance and this increase was compounded by both visual feedback withdrawal and cutaneous desensitization. Both ApEn (mediolateral and anteroposterior COP motion) and CrossApEn increased with the withdrawal of visual feedback during the tandem stance, but decreased significantly during normal stance. The results of the study demonstrate that plantar desensitization only affected the magnitude of sway variability but did not alter its time-dependent structure. Contrasting effects on the structure of postural sway variability with visual feedback withdrawal were observed during the different stances, highlighting the role of task demands in postural dynamics.     

A predictive model of anxiety and depression symptoms after a lower limb amputation

Background

Patients with Diabetic Foot Ulcer (DFU) show high levels of depression and anxiety symptoms. The loss of a limb is undoubtedly a devastating experience and several studies have shown that anxiety and depression symptoms are a common reaction after a lower limb amputation (LLA). However, no study has focused on the immediate emotional reactions to LLA as a personal factor based on the ICF Model.