Background. Acute hematogenous osteomyelitis in the lesion of the proximal femur causes hypofunction or destruction of the metaepiphyseal growth zone of the femur. Theoretically, this leads to the formation of orthopedic consequences, including shortening of the lower limb. Aim. The study aimed to examine the plantographic characteristics of the feet in children with a lesion of the proximal femur and analyze the influence of the regularities of plantar pressure distribution in the asymmetry of the load on the lower limbs. Material and methods. Total 15 pediatric patients aged 6–16 years with consequences of acute hematogenous osteomyelitis of the proximal femur and shortening of the affected lower limb by 1.0–6.0 cm were examined. In addition, 15 healthy children belonging to the same age were examined for comparison. Stabilometry and plantography methods were used, and the statistical study included correlation and regression analysis. Results. When we conducted tests with a double-support load on the feet, in comparison to healthy children, pediatric patients exhibited a significant decrease in the value of the anterior index of the support t in both the affected and unaffected sides. The parameters of other support indices (namely, m, s, and l) of the contralateral feet in patients were within the normal range, indicating the functional consistency of the corresponding arches of the feet, providing static and dynamic limb support ability. However, the correlation and regression analysis showed that, in comparison with the norm, the foot support ability in pediatric patients is implemented due to the strengthening of the functional relationship between the inner and the medial longitudinal arches of the foot on the intact side and the inversion of the interaction of the longitudinal arches with the transverse arch on the side of the lesion. Conclusion. In children with consequences of acute hematogenous osteomyelitis of the proximal femur, the parameters of the plantographic characteristics indicate a change in the activity and consistency of the muscles that form all the feet arches on both the affected and intact lower limbs.
Background. In modern orthopedics, the problem of unilateral shortening of the lower limbs in children is extremely important. In the process of child growth, there occurs progression of the shortened segment, which leads to anatomical asymmetry of the lower limbs and an increase in the imbalance of the limb load. Secondary deformities of the pelvis and spine aggravate the patients disability. The features of abnormal postural balance of the body depending on the etiology of the disease, such as congenital or acquired, as well as the degree of preservation of motor stereotypes in children with unilateral shortening of the lower limbs, are still understudied. Aim. The aims of this work are to study postural stability in children with unilateral shortening of the lower limbs and to assess the disorders of body balance depending on the etiology of the lesion. Materials and methods. The standard stabilometric values of 11 healthy children (average age, 11.9 0.73 years) were determined (group 1), as well as the statokinesiogram parameters in 22 patients with unilateral shortening of the lower limb. The second group included 11 children (average age, 11.9 1.05 years) with congenital shortening of the lower limb (average shortening, 4.8 0.8 cm). The third group also consisted of 11 children (average age, 12.2 0.78 years), but with acquired shortening of the lower limb (average shortening, 4.5 0.38 cm). Statistical research included correlation analysis. Results. A significant decrease in the stability of the vertical balance was observed in both groups of patients, which was demonstrated by pronounced deviations from the nominal values of stabilometric parameters, compared with healthy children: an increased center of pressure displacement, large values of the statokinesiogram area, and the length of the pressure displacement path. It was possible to determine the state of adaptive postural mechanisms for assessing the formation of the degree of adequacy of the motor strategy in patients with unilateral shortening of the lower limb, depending on the etiology of the lesion, owing to the method of stabilometry. Conclusion. An appropriate adaptive motor stereotype has been formed in patients with acquired shortening of the lower limb; in the new conditions, the system for ensuring postural balance is stabilized. There is a different strategy for maintaining posture stability characterized by a nonoptimal motor stereotype in patients with congenital shortening of the lower limb. The stabilometric assessment of the asymmetry of the lower limb load is a promising method for studying the formation of compensatory mechanisms for controlling the locomotion system, which is important when planning rehabilitation measures.
Introduction. Stenosis of the spinal canal can be accompanied by abnormalities of gait and body balance. At the same time, changes occurring in the postural control in children with spinal stenosis remain unexplored. Aim. To study postural stability in children with spinal stenosis and assess the imbalance of the body depending on the level of stenosis localization. Material and methods. This study investigated 14 patients, aged 10–17 years, with stenosis of the spinal canal. The first group consisted of seven patients with spinal stenosis due to congenital deformity of the thoracic spine with spinal cord compression at the stenosis level. The second group consisted of seven patients with spondylolisthesis of the L5 vertebra body of grades 3–4, accompanied with spinal cord root compression. The control group consisted of seven healthy children of the same age. We used stabilometry, and statistical study included correlation-regression analysis. Results. A significant deviation of the stabilometric parameters was noted only in the first group of patients (p < 0.05). In the same group, a strong correlation was found between the parameters of statokinesiogram: area S, length L, amplitude A, and mean power level of the spectrum of f 60%, which were much higher than those of healthy children, which may indicate a pathologically high synchronization of the vertical balance control system of the body. Other changes were revealed, such as a strong relationship between L/S and A at normal stabilometric parameters and a moderate force between L/A and f 60%, indicating postural deficiency in the group of patients with stenosis at the level of the lumbosacral spine. Correlation-regression analysis for assessing the postural balance in both groups of patients showed a correlation between parameters L, S, A, and f 60%, which were significantly higher than those in healthy children and most pronounced in the thoracic localization of stenosis. Conclusion. The system of maintaining vertical balance of the body in children with stenosis of the spinal canal at the level of the thoracic spine has a more pronounced deficiency than that in patients with stenosis of the canal at the lumbosacral level. To reveal hidden violations of the postural balance, the relationship between length, area, amplitude, and mean power of the statokinesiogram must be evaluated.
Background. Deforming arthrosis of the hip joint in children leads to serious disorders of the walking biomechanics due to a decrease in the support and motor functions of the lower limbs. In patients with stage III coxarthrosis, when the potential of reconstructive surgeries has been exhausted, a total hip arthroplasty is performed. Objective. To study the biomechanical parameters of support ability of the lower limbs in children with bilateral coxarthrosis before and after bilateral total hip arthroplasty. Material and methods. Stabilometric and plantographic studies were conducted in 12 patients with bilateral coxarthrosis, aged from 13 to 17 years old, before and after hip arthroplasty. The time interval between operations on the contralateral joints ranged from 6 to 12 months. The control group consisted of 15 children of the same age, with no signs of orthopedic disorders. Results. Before carrying out hip arthroplasty in patients, the tension of the statokinetic system was revealed during the implementation of support for the vertical balance of the body. The plantography method made it possible to diagnose disorders of the support function of the feet in the form of supination rigidity of the anterior section, a tendency toward rigidity of the internal longitudinal arch. After bilateral total hip arthroplasty in patients, the stability of the vertical posture improved, the support ability of the heads of the 1st metatarsal bones was significantly restored, and the weight-bearing distribution across the foot sections was normalized. Conclusion. After bilateral hip arthroplasty in patients with coxarthrosis, stabilization of the support function of the postoperative lower limbs was achieved.
Резюме. Исследование анатомо-функционального состояния стоп у детей с пороком развития переднего отдела является актуальной задачей, решение которой имеет существенное теоретическое и практическое значение . Цель исследования -изучение с помощью методики компьютерной плантографии морфофункциональных параметров стоп у детей с пороками развития переднего отдела для оценки дисбаланса нагрузок и выявления структурных и функциональных нарушений . Был проведен анализ плантограмм 64 детей в возрасте от 5 до 16 лет с указанной патологией с последующей математической обработкой плантографических характеристик стоп (углов, индексов и коэффициентов) . Характер выявленных отклонений свидетельствует о нарушении ста-тики пораженной стопы и неполноценности ее динамической функции (нарушена фаза переката через перед-ний отдел стопы при ходьбе), что указывает на целесообразность хирургического восстановления анатомии стопы с целью улучшения ее функции . Assessment of the anatomical and functional state of the feet in of children with malformations of the anterior foot has significant theoretical and practical value . The purpose of this study was to investigate the morphological and functional parameters of the feet in children with malformations of the anterior foot to assess load imbalance and to identify structural and functional disorders using computed plantography techniques . A plantogram analysis was conducted in 64 children aged 5-16 years with foot malformations followed by mathematical processing of plantographical characteristics of the feet (angles, indices, and ratios) . The nature of the revealed deviations indicates disturbances of the statics of the affected foot and the inferiority of its dynamic functions (disturbed phase of rolling through the forefoot when walking), which indicates the appropriateness of surgical reconstruction of the anatomy of the foot to improve function .
Relevance. Treatment of children with post-burn foot deformities is an important task of reconstructive plastic surgery. The scars formed on the back surface of the feet, even with adequate surgical approach, in the acute period of thermal injury, further often lead to deformities of the entire foot, which leads to a derangement of its support function. The importance of the problem lies in the fact that with the growth of the child, secondary abnormal changes develop on the part of the joints of the lower extremities and the spine, leading to impaired locomotor function, including deviations in the body balance control system. Purpose of the study. To study postural stability in children with post-burn foot deformities before and after surgical treatment. Material and methods. The stabilometric study was conducted in 12 patients with post-burn cicatricial foot deformity, the average age of the patients was 9.8 ± 0.93 years old. The control group consisted of 12 children of the same age with no signs of orthopedic abnormality. To assess the results, the methods of descriptive statistics with the inclusion of correlation and regression analysis were used. Results. In patients with post-burn cicatricial deformity of the foot at the pre-treatment stage, a compensatory redistribution of the static load towards the intact lower limb was revealed. Analysis of postural control indicators in patients of the main group showed an abnormal increase in the synchronization of the system of body balance control. After reconstructive operations on the affected foot, symmetry of the distribution of the load and restoration of the support of the limb of the affected side were noted. Correlation analysis revealed a pronounced decrease in abnormal hypersynchronization between stabilometric parameters, which may indicate a trend towards normalization of the postural control strategy in patients after treatment. Conclusion. Elimination of post-burn foot deformity contributed to the restoration of its anatomical shape and was accompanied by pronounced positive dynamics in the state of the system of vertical balance of the patient’s body.
Исследование анатомофункционального состояния стоп у детей с врожденной косолапостью является актуальной задачей, решение которой имеет существенное теоретическое и практическое значение. Цель исследования -изучение с помощью методики компьютерной плантографии морфофункциональных па-раметров стопы для оценки степени нарушения ее опорной функции при врожденной косолапости. Были определены плантографические характеристики стоп с указанной патологией у 65 детей в возрасте от 4 до 16 лет. Проведена математическая обработка плантографических характеристик стоп: пяточно-осевого и пяточно-пучкового углов, угла между наружными касательными, на основании чего были определены границы значений угловых величин в зависимости от степени тяжести деформации стоп. Предложенный метод анализа плантограмм стоп статистически достоверен для классификации врожденной косолапости различной степени тяжести: легкой, средней и тяжелой, что является дополнением к клинико-рентгеноло-гическому методу и позволяет оценивать опорную функцию стоп.Ключевые слова: стопа, косолапость, плантография.
Background. In children with spondylolisthesis, there are still unexplained aspects in the relationship of the degree of displacement of the L5 vertebra with the severity of the clinical picture and neurological disorders. At the same time, aspects of the mutual aggravating influence of the indicated spinal disorder on the condition of the feet have not been studied. Therefore, the problem of identifying disorder of foot function in children with spinal spondylolisthesis of the L5 vertebra is relevant.Aim of the study — to evaluate the deviations in parameters of the transverse and longitudinal arches of feet in children suffering from severe spondylolisthesis of the L5 vertebra.Materials and Methods. In the period from 2016 to 2018, 12 children aged 14.1 y.o. [12,7; 15,5] were examined with spondylolisthesis of the L5 vertebral body of grade III-IV, accompanied by stenosis of the spinal canal at the same level and by compression of the roots of the spinal cord. Imaging diagnostics included multispiral computed tomography (MSCT) and magnetic resonance imaging (MRI). To estimate the function of the feet, double-bearing and single-bearing plantography was used. The data for the control group included only plantographic examinations of 12 healthy children of the same age.Results. In patients with spondylolisthesis, the mean value of the anterior t and intermediate s plantographic bearing indices were significantly lower than those of healthy children. At the same time, in tests with an increased load on the foot in patients, there was no significant increase in the mean anterior t and medial m indices, which indicates the dynamic rigidity of the transverse and medial longitudinal arches. The value of the lateral plantographic index l showed its significant pathological increase compared with the normal value at double-bearing load, which indicates the static rigidity of the lateral longitudinal arch. Correlation analysis demonstrated that, against the normal state, the bearing ability of the feet in sick children is realized through a pathological strengthening of the functional relationship between the arches of the foot at double-bearing load and a non-physiological reduction of the interaction between arches at single-bearing load.Conclusion. In children with severe forms of vertebra spondylolisthesis, the parameters of plantographic characteristics indicate the rigidity of the arches of the feet and the distortion of their bearing pattern. It is necessary to take into account the aggravating effect of rigid feet on the state of the spine and include the examination of the bearing function of the feet in the algorithm for the comprehensive diagnosis of children with spondylolisthesis.
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