To analyze the differences in the vertical ground reaction force (GRF) variables of hemiplegic patients compared with a control group, and between the affected and unaffected limbs of hemiplegic patients using foot scans.
Patients (n=20) with hemiplegia and healthy volunteers (n=20) underwent vertical force analysis. We measured the following: the first and second peak forces (F1, F2) and the percent stances at which they occurred (T1, T2); the vertical force impulse (VFI) and stance times. The GRF results were compared between the hemiplegic patients and control individuals, and between the affected and unaffected limbs of hemiplegic patients. Additionally, we analyzed the impulse of the unaffected limb according to the motor assessment scale (MAS), Brunnstrom stage, and a Timed Up and Go Test.
The F1s and F2s of the affected and unaffected limbs were significantly less than those of the normal control individuals (p<0.05). The T1s of both the affected and unaffected limbs of the patients were greater than control individuals, whilst the T2s were lower (p<0.05). Greater impulses and stance times were recorded on both sides of the patients than in the limbs of the control individuals (p<0.05). The MAS, Brunnstrom stage and Timed Up and Go Test results were significantly correlated with the VFI of the unaffected limbs (p<0.05).
The high impulse values of the unaffected limb were associated with complications during gait rehabilitation. Therefore, these results suggest that unaffected limbs should also be taken into consideration in these patients.
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To investigate the characteristics of foot deformities in patients with Charcot-Marie-Tooth (CMT) disease compared with normal persons according to severity of disease.
Sixty-two patients with CMT disease were recruited for this study. The normal control group was composed of 28 healthy people without any foot deformity. Patients were classified into a mild group and a moderate group according to the CMT neuropathy score. Ten typical radiological angles representing foot deformities such as pes equinus and pes varus were measured. The CMT group angles were compared with those of the normal control group, and those of the mild group were also compared with those of the moderate group.
The lateral (Lat.) talo-first metatarsal angle, anteroposterior talo-first metatarsal angle, Lat. calcaneal-first metatarsal angle, Lat. naviocuboid overlap, Lat. calcaneal pitch, Lat. tibiocalcaneal angle, and Lat. talocalcaneal angle in the CMT group showed a significant difference compared to the normal control group (p<0.05). These findings revealed CMT patients have pes cavus, forefoot adduction, midfoot supination and pes varus deformity. Compared to the mild group, the moderate group significantly showed an increased Lat. calcaneal pitch and decreased Lat. calcaneal-first metatarsal angle, Lat. tibiocalcaneal angle, Lat. talocalcaneal angle, and Lat. talo-first metatarsal angle (p<0.05). These findings revealed that the pes cavus deformity of CMT patients tend to be worse with disease severity.
The characteristic equinovarus foot deformity patterns in CMT patients were revealed and these deformities tended to be worse with disease severity. Radiographic measures may be useful for the investigation of foot deformities in CMT patients.
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The purpose of this study is to evaluate the effectiveness of intramuscular botulinum toxin A injection in cerebral palsy with foot deformities using roentgenogram. We have studied 26 children with cerebral palsy(age 3 to 13 years old). They were twenty spastic diplegias, three hemiplegias and three mixed types(spasticity and athetosis). The botulinum toxin A was injected into gastrocnemius or peroneous muscles with an electromyographic guidance. Before injections, passive joint angles of the ankle were assessed by the goniometric measurements. A plantar-flexion angle of talus, dorsiflexion angle of calcaneous, and talar-calcaneal divergence angle were measured using the lateral and anterior-posterior roentgenograms of the foot with weight- bearing for the assessment of equinovalgus of ankle. Follow-up assessments were performed at 1 and 3 months after the injection. At 1 month after the injection into gastrocnemius muscle, there was an increased range of passive ankle joint motion, decreased plantar-flexion angle of talus, and increased dorsiflexion angle of calcaneous. These changes were still significant at 3 months after the injection. After the injection into peroneous muscle, the talar-calcaneal divergence angle was significantly decreased. This study provides the evidence that the treatment with botulinum toxin A improves the ankle joint motion in cerebral palsy with feet deformities by reducing hypertonicity, spasticity and dynamic contracture. In addition, the lateral and anterior- posterior roentgenograms of the foot with weight bearing seems to be the simple and objective methods to evaluate the effectiveness of intramuscular botulinum toxin A injection in cerebral palsy with foot deformities.
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