Clin Orthop Surg.  2017 Sep;9(3):363-373. 10.4055/cios.2017.9.3.363.

Gait Analysis of Symptomatic Flatfoot in Children: An Observational Study

• Kim HY
• Shin HS
• Ko JH
• Cha YH
• Ahn JH
• Hwang JY

• KMID: 2412274
• DOI: http://doi.org/10.4055/cios.2017.9.3.363

Abstract

BACKGROUND
Flatfoot deformity is a lever arm disease that incurs kinetic inefficiency during gait. The purpose of this study was to measure the degree of kinetic inefficiency by comparing the gait analysis data of a flatfoot group with a normal control group.
METHODS
The patient group consisted of 26 children (21 males and 5 females) with symptomatic flatfoot. They were examined with gait analysis between May 2005 and February 2014. Exclusion criteria were patients with secondary flatfoot caused by neuromuscular disorders, tarsal coalition, vertical talus, or others. Patients' mean age was 9.5 years (range, 7 to 13 years). The gait analysis data of the study group and the normal control group were compared.
RESULTS
The mean vertical ground reaction force (GRF) in the push-off phase was 0.99 for the patient group and 1.15 for the control group (p < 0.05). The mean ankle moment in the sagittal plane during the push-off phase was 0.89 for the patient group and 1.27 for the control group (p < 0.05). The mean ankle power in the sagittal plane during the push-off phase was 1.38 for the patient group and 2.52 for the control group (p < 0.05). The aforementioned results show that patients with pes planovalgus had a reduction of moment, power, and GRF in the push-off phase during gait.
CONCLUSIONS
Symptomatic flatfeet had a moment inefficiency of 30% and power inefficiency of 45% during gait compared to feet with preserved medial longitudinal arches.

Keyword

Foot; Flexible flatfoot; Kinetics; Gait

MeSH Terms

Ankle Joint/physiopathology
Biomechanical Phenomena
Child
Female
Flatfoot/diagnostic imaging/*physiopathology
Gait/*physiology
Humans
Male
Radiography
Video Recording
Walking/physiology

Figure

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  Fig. 1 Standing lateral radiograph (A) and standing anteroposterior (AP) radiograph (B) showing flatfoot deformity. Measurements on the standing lateral view (C) and standing AP view (D).

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  Fig. 2 Coordinates of the ground reaction force measurement system (x, y, and z moments about the vertical axis).

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  Fig. 3 Kinematics and kinetics of the foot and ankle complex. Coronal plane kinematics (A) and sagittal plane kinematics (B) of the knee joint. The knee joint was bent (①–③) during the entire gait cycle, whereas the ankle joint became valgus (Val) in the coronal plane. (C) Transverse plane kinematics of the knee joint. (D) Coronal plane kinematics of the ankle joint. Heel valgus was evident throughout the gait cycle in the flatfoot group (④). (E) Sagittal plane kinematics of the ankle joint. The maximum foot dorsiflexion (⑤) at the end of the second rocker in the sagittal plane was similar to that of the control group; however, the maximal plantar flexion (⑥) at the end of the third rocker was shortened compared with that of the control group. (F) Foot progression angle. Var: varus, RHS: right heel strike, LTO: left toe off, LHS: left heel strike, RTO: right toe off, Ext: extension, Flx: flexion, Int: internal rotation, Pla: plantar, Dor: dorsiflexion.

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  Fig. 4 Ground reaction force (GRF) of the patient group and the control group in 3 planes. (A) Vertical load (FLOAD1, FLOAD2, and FLOAD3). (B) Fore-aft shear force (FAP1 and FAP2). (C) Medial-lateral shear force (FML0, FML1, and FML2). Statistical analysis was performed using the peak values of the GRF vector in each graph.

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  Fig. 5 Comparison of foot and ankle kinetics between the patient and control groups. (A) Sagittal plane moment of the ankle joint. Values of moment and power at the ankle joint were measured at the peak of the graph. A1Smo: the first peak of ankle moment in the sagittal plane, A2Smo: the second peak of ankle moment in the sagittal plane. (B) Sagittal plane power of the ankle joint. A1Spw: the first peak of ankle power in the sagittal plane, A2Spw: the second peak of ankle power in the sagittal plane, Dor: dorsiflexion, Pla: plantar, RHS: right heel strike, LTO: left toe off, LHS: left heel strike, RTO: right toe off, Abs: absorption, Gen: generation.

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