Comparison of 2 Conservative Treatment Approaches for the Flat Foot in Children Aged 5 to 10: Foot Orthoses Versus Foot Orthoses Supplemented With Zukunft-Huber Manual Therapy.

The aim was to find if foot orthotics alone can improve flat feet in children and analyze how the addition of Zukunft-Huber manual therapy and corrective bandaging changes the outcome. Forty-nine children aged 5 to 10 with asymptomatic flexible flat feet were divided into 2 groups. The first was treated with foot orthoses alone, in the second wearing foot orthoses was supplemented with Zukunft-Huber manual therapy and corrective bandaging. Pedobarography during gait was performed before the therapy and after a year. In the first group decrease in arch index, width, force, and area of midfoot, increase in force MH2 and area hindfoot was found, in the second decrease in arch index, width, force, and area of midfoot, increase in force under metatarsal head second, third, fourth, and fifth, area metatarsal head fourth and area hindfoot. Both methods showed positive changes, but foot orthoses with additional intervention were more effective.

How to Define Pediatric Flatfoot: Comparison of 2 Methods: Foot Posture in Static and Dynamic Conditions in Children 5 to 9 Years Old.

LEVELS OF EVIDENCE: Prospective cohort study.

Effect of Plano-Valgus Foot on Lower-Extremity Kinematics and Spatiotemporal Gait Parameters in Children of Age 5-9.

Aim of the study was to see how a definition of the flexible flat foot (FFF) influences the results of gait evaluation in a group of 49 children with clinically established FFF. Objective gait analysis was performed using VICON system with Kistler force platforms. The gait parameters were compared between healthy feet and FFF using two classifications: in static and dynamic conditions. In static condition, the ink footprints with Clarke's graphics were used for classification, and in dynamic condition, the Arch Index from Emed pedobarograph while walking was used for classification. When the type of the foot was based on Clarke's graphics, no statistically significant differences were found. When the division was done according to the Arch Index, statistically significant differences between flat feet and normal feet groups were found for normalized gait speed, normalized cadence, pelvic rotation, ankle range of motion in sagittal plane, range of motion of foot progression, and two parameters of a vertical component of the ground reaction force: FZ2 (middle of stance phase) and FZ3 (push-off). Some statically flat feet function well during walking due to dynamic correction mechanisms.

Assessment of the coronal plane trunk symmetry in children.

Objective: To present the use of Posterior Trunk Symmetry Index (POTSI) and Anterior Trunk Symmetry Index (ATSI) for the assessment of the coronal plane trunk symmetry in children; to compare the two measures in individual subjects and to evaluate the possible association of each measure with gender and age (<6 vs. >6 years). Methods: Trunk photographs in uncorrected standing position were taken and analyzed to calculate POTSI and ATSI from measurements in 50 healthy children (64% girls), mean age 7.1 ± 3.38 years. The raw data were normalized. Results: Mean POTSI: 28.45 ± 13.28 (normal values <27); mean ATSI: 35.54 ± 20.81 (normal range not established). No correlation was found between the POTSI and ATSI (r = 0.179; p = 0.21). There were no differences in the POTSI and ATSI between genders and age groups (<6 vs. >6 years). Trunk symmetry in coronal plane may be assessed with POTSI and ATSI parameters in children as young as approximately 2 years old if they cooperate. Conclusion: In healthy children, the values of POTSI and ATSI were independent of gender and chronological age. The combined use of POTSI and ATSI measurements in the same child seems a valuable tool for comprehensive trunk symmetry assessment but its application to physiotherapy practice requires further studies.

How does applying of one or two orthosis influence gait parameters of children with hemiplegia?

The aim of this study was to evaluate how wearing one or two orthoses influence the gait parameters in children with hemiplegia. Four children with hemiplegic cerebral palsy participated in the study. Patients were from 3 to 7 years old; one girl and three boys; one patient with right side hemiplegia, three patients with left side hemiplegia. Patients underwent the VICON MX system gait analysis three times (sessions): one with bare feet, the other two with shoes and orthoses: one with orthoses used unilaterally on palsied limb, one with orthoses used bilaterally. The following gait parameters were analyzed: velocity, cadence, pelvis tilt, range of pelvic movement in sagittal plane, separately for affected and non-affected side: step length, stance time (as a percentage of the gait cycle), range of hip movement in sagittal plane, knee flexion at initial contact, maximum knee flexion in swing phase. Results of the study showed which and how many gait parameters changed while wearing one in comparison with two orthoses. The results did not give a clear indication which condition is better: wearing one or two orthoses, however they suggest that when the orthotic devices are considered for patients with hemiplegic cerebral palsy, the objective, instrumented gait analysis can be used to take the best decision whether one or two orthoses should be prescribed.

Reliability of four tests to assess body posture and the range of selected movements in individuals with spinal muscular atrophy.

BACKGROUND: The majority of individuals with spinal muscular atrophy (SMA) experience progressive skeletal deformities which may affect the quality of life and mobility. To date, no studies have evaluated the reliability of tests assessing body posture and joint mobility in SMA patients. The purpose of this study was to assess the reliability of Cervical Rotation test (CR), Supine Angle of Trunk Rotation test (SATR), Hip Extension test (HE) and Pelvic Obliquity test (PO) developed to evaluate the musculoskeletal system in SMA individuals. METHODS: Thirty individuals (12 girls and 18 boys) aged 4-15 with SMA type II (n = 24) and III (n = 6) confirmed by genetic examinations were qualified for the study. The participants were examined twice by three physiotherapists on the same day. The examination included four tests, i.e. CR, SATR, HE and PO tests aimed at assessing ranges of rotation in the cervical spine, chest deformities, ranges of hip extension and pelvis position while sitting. Statistical calculations were made with the use of statistical software IBM SPSS Statistics version 20. Reliability was assessed using the Intraclass Correlation Coefficient (ICC). RESULTS: Intraobserver reliability was excellent for CR (ICC range 0.839-0.911), SATR (ICC range 0.918-0.939 - the upper part of the sternum; ICC range 0.951-0.975 - the lower part of the sternum), HE (ICC range 0.988-0,991) and PO (ICC range 0.896-0.935) tests. The interobserver ICC reached the excellent values in CR (ICC range 0.912-0.920), SATR (ICC = 0.888 - the upper part of the sternum, ICC = 0.951 - the lower part of the sternum), HE (ICC range 0.922-0.923) and PO (ICC = 0.928) tests. CONCLUSIONS: CR, SATR, HE and PO tests are reliable and may be used for examining individuals with SMA. The application of these tests provides a possibility to detect early changes in the musculoskeletal system in children and adolescents and to assess the effectiveness of the implemented pharmacotherapy and rehabilitation.