Children's feet: Role of Dynamic Pedobarograph in Assessing Cavovarus Feet

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The Role of the Dynamic Pedobarograph in Assessing Treatment of

Cavovarus Feet in Children With Charcot-Marie-Tooth Disease.

Journal of Pediatric Orthopaedics. 27(5):510-516, July/August 2007.

http://www.mdlinx.com/OrthoLinx/xml-article.cfm/1898287

Chan, Gilbert MD; Sampath, Jayanth MD; , Freeman MD; Riddle,

C. MHS, PA-C; Nagai, K. MD, PhD; Kumar, S. Jay MD

Abstract:

We used the dynamic pedobarographs to study pressure distribution

patterns in the foot after surgical correction of cavovarus feet. We

also assessed the influence of ankle power generation on pressure

distribution in these feet. Nine children (14 feet) diagnosed with

Charcot-Marie-Tooth disease who had undergone operative treatment

with a combination of osteotomies and muscle transfers were the

subjects of this study. Preoperative and postoperative

pedobarographic measurements recorded included pressure over the

medial forefoot, lateral forefoot, medial midfoot (MMF), lateral

midfoot (LMF), and heel segments. In 6 patients (9 feet) who had a

complete gait analysis, the power generation of the ankle was also

obtained both preoperatively and postoperatively. Lateral

radiographic measurements included the (1) talus-first metatarsal

angle, (2) calcaneus-first metatarsal angle, and (3) calcaneal pitch.

The radiographs showed significant improvements in all 3 angles.

Increased LMF and decreased forefoot pressures were seen on

preoperative pedobarographic measures. Postoperatively, improvement

in pressure at the LMF was seen. When postoperative measurements

were compared with the normal values, only the LMF was similar; the

other 4 segments showed decreased forefoot and MMF pressures and

increased heel pressures (P = 0.000 for the lateral forefoot and

MMF; 0.040 for the heel and medial forefoot). The heel pressures

displayed an inverse relationship to ankle power generation.

The amount of correction achieved radiographically did not correlate

with pedobarographic measurements. The increased heel pressure that

was noted was not addressed by treatment. Normalization of pressure

patterns should be the goal in treating children with symptomatic

cavovarus feet. Although the foot deformity is corrected completely

in neuromuscular disorders, pressure distribution was not

normalized, and therefore, symptoms might persist.

Both patients and parents should be informed about this possible

problem before surgical intervention.