特发性扁平足儿童和青少年胫骨远端内翻畸形：能否通过三维运动分析进行预测？

IF 2.2 3区医学 Q3 NEUROSCIENCES

Gait & posture Pub Date : 2024-11-20 DOI:10.1016/j.gaitpost.2024.11.012

Chakravarthy Ugandhar Dussa , Nadine Dostal , Harald Böhm

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引用次数: 0

摘要

背景：胫骨远端外翻畸形虽然常见于各种疾病，但对特发性扁平足的研究并不广泛。它在临床上表现为后足外翻，模仿扁平足畸形，需要通过 X 光检查才能发现。其严重程度可通过静止小腿骨角度和站立胫骨-小腿骨角度（STCA）进行量化，但其对识别胫骨远端外翻畸形的预后价值仍不明确。在特发性扁平足患者中使用常规有创X光片还存在争议，因为以调查为目的的仪器无创步态分析越来越受欢迎：本研究旨在通过放射摄影确定特发性扁平足儿童和青少年胫骨远端外翻畸形的患病率，并确定在站立或行走过程中评估的可预测该畸形的参数：这项回顾性研究纳入了7-17岁的特发性扁平足门诊患者。参与者接受了临床检查、足踝X光检查和仪器三维步态分析。胫骨外侧远端角度（LDTA）小于86°表示外翻畸形，LDTA在86-92°之间视为正常。分析分为两组：踝关节外翻（LDTA < 86°）和正常踝关节（86-92°）。STCA、踝关节倾斜度、两跖间高度差（IMHD）和八个运动学参数与 LDTA 相关：研究包括 136 名患者（平均年龄 11.5 岁，SD=2.2）。63名患者踝关节外翻（LDTA为83.8°，SD=1.7°），73名患者踝关节正常（LDTA为88.8°，SD=1.3°），两组间差异显著（P < 0.001）。站立时的 STCA 是最好的预测指标，但它只能解释 9% 的方差，限制了预测的准确性：在特发性扁平足病例中，胫骨远端外翻畸形的发生率为42%，由于临床上无法怀疑这种畸形，因此强调了常规踝关节X光检查的必要性。进一步的研究应探讨生物力学效应及其对治疗的临床影响。

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Valgus deformity of the distal tibia in children and adolescents with idiopathic flatfoot: Can it be predicted using 3D movement analysis?

Background

Distal tibial valgus deformity, though common in various medical conditions, has not been extensively studied in idiopathic flatfoot. It clinically presents as hindfoot valgus, mimicking flatfoot deformity, and requires X-rays for detection. Severity is quantified using resting calcaneal angle and standing tibio-calcaneal angles (STCA), but their prognostic value for identifying distal tibial valgus deformity remains unclear. The use of routine invasive radiographs in idiopathic flatfoot is controversial as instrumented non-invasive gait analysis gains popularity for investigative purposes.

Research question

This study aimed to determine the prevalence of distal tibial valgus deformity in children and adolescents with idiopathic flatfoot using radiography and to identify parameters assessed during standing or walking that predict this deformity.

Methods

A retrospective study included outpatients aged 7–17 years with idiopathic flatfeet. Participants underwent clinical examination, foot and ankle X-rays, and instrumented 3-dimensional gait analysis. A lateral distal tibia angle (LDTA) < 86° indicated valgus deformity, with LDTA 86–92° considered normal. Two groups were analysed: ankle valgus (LDTA < 86°) and normal ankle (86–92°). STCA, ankle tilt, intermalleolar height difference (IMHD), and eight kinematic parameters were correlated with LDTA.

Results

The study included 136 patients (mean age 11.5 years, SD=2.2). Sixty-three patients had ankle valgus (LDTA 83.8°, SD=1.7°), and 73 had normal ankles (LDTA 88.8°, SD=1.3°), showing a significant difference between groups (p < 0.001). STCA during standing was the best predictor, though it explained only 9 % of variance, limiting robust prediction.

Significance

The prevalence of distal tibial valgus deformity was 42 % in idiopathic flatfoot cases, highlighting the necessity for routine ankle radiographs due to the inability to clinically suspect this deformity. Further studies should explore the biomechanical effects and their clinical implications for management.

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来源期刊

Gait & posture 医学-神经科学

CiteScore

4.70

自引率

12.50%

发文量

616

审稿时长

6 months

期刊介绍： Gait & Posture is a vehicle for the publication of up-to-date basic and clinical research on all aspects of locomotion and balance. The topics covered include: Techniques for the measurement of gait and posture, and the standardization of results presentation; Studies of normal and pathological gait; Treatment of gait and postural abnormalities; Biomechanical and theoretical approaches to gait and posture; Mathematical models of joint and muscle mechanics; Neurological and musculoskeletal function in gait and posture; The evolution of upright posture and bipedal locomotion; Adaptations of carrying loads, walking on uneven surfaces, climbing stairs etc; spinal biomechanics only if they are directly related to gait and/or posture and are of general interest to our readers; The effect of aging and development on gait and posture; Psychological and cultural aspects of gait; Patient education.