Objective Signs of Foot Deformities in Children with Spastic Form of Cerebral Paralysis: Justification of Individual Approach to Footwear Support

Cover Page


Relevance. Foot deformities are the most common locomotor pathology in children with infantile cerebral paralysis. At the same time many children suffering from this pathology wear standard shoes that do not take into account the individual foot anatomy. Purpose of the study — to justify the expedience of individual approach to orthopaedic support for children with infantile cerebral paralysis. Materials and methods. The authors examined 220 feet in 110 patients aging from 3 to 18 years: 62 patients with spastic form of infantile cerebral paralysis and 48 children who were examined during periodic screening at general education institutions (control group). Clinical examination methods, computerized plantography and podometry by flatbed foot scanning (ventrally, posteriorly, medially) in standing position were used in the present study. Results. Statistically significant variances (p*<0.005) were obtained for 8 indicators of foot deformity in three planes in children with infantile cerebral paralysis as compared to the norm, as well as differences between the groups of patients with varying degree of disorders in gross motor functions. The authors established pathological foot deformities in children with infantile cerebral paralysis; statistically significant variances in types and degrees of these disorders for patient groups with different levels of gross motor functions disorders; distinctiveness of foot deformities within each of the groups. Conclusion. Objectively instrumental method was used to identify the main components of foot deformities in patients with infantile cerebral paralysis with preservation and realization of walking capability: loss of height of longitudinal arches, midfoot pronation and hindfoot valgus, hallux valgus. Increased elevation of longitudinal arches (cavus foot), midfoot supination and hindfoot varus are rarer components of deformities occurring more often in patients with severer forms of the pathology. Strong variation in the spread of foot anatomy parameters observed within different groups of motor dysfunctions indicates the expediency of individual approach to footwear recommendations: standard, less or more complex orthopaedic shoes. Implementation of obtained data into the clinical practice requires additional series of biomechanical trials aimed at elaboration of criteria for recommendations and efficiency evaluation of various footwear types that take into account not only specifics of foot anatomy but also its statodynamic function as well as the level of gross motor functions of a particular patient. 

About the authors

L. M. Smirnova

Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht,
Saint-Petersburg State Electrotechnical University “LE TI” of V.I. Ulyanov (Lenin)

Email: fake@neicon.ru

Dr. Sci. (Eng.), Leading Researcher, Department of Biomechanical Researches of Musculoskeletal System; professor Biotechnical Systens Chair

St. Petersburg

Russian Federation

E. I. Dzhomardly

Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht

Email: fake@neicon.ru

Orthopedic Surgeon, PhD Student

St. Petersburg

Russian Federation

A. A. Koltsov

Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht

Author for correspondence.
Email: katandr2007@yandex.ru

Cand. Sci. (Med.), Orthopedic Surgeon, the Chief of First Orthopedic Department for Children

St. Petersburg

Russian Federation


  1. Armand S., Decoulon G., Bonnefoy-Mazure A. Gait analysis in children with cerebral palsy. EFORT Open Rev. 2016;1:448-460. doi: 10.1302/2058-5241.1.000052.
  2. Colver A., Fairhurst C., Pharoah P.O. Cerebral palsy. Lancet. 2014; 383: 1240-1249. doi: 10.1016/S0140-6736(13)61835-8.
  3. Narayanan U.G. Lower Limb Deformity in Neuromuscular Disorders: Pathophysiology, Assessment, Goals, and Principles of Management. In: Pediatric lower limb deformities: principles and techniques of management. Cham : Springer, 2016; 267-269.
  4. Tolentino J., Talente G. Cerebral Palsy. In: Care of Adults with Chronic Childhood Conditions. Cham : Springer. 2016; 67-85. doi: 10.1007/978-3-319-43827-6_5.
  5. Stavsky M., Mor O., Mastrolia S.A., Greenbaum S., Than N.G., Erez O. Cerebral palsy — trends in epidemiology and recent development in prenatal mechanisms of disease treatment, and prevention. Front Pediatr. 2017;5:21. doi: 10.3389/fped.2017.00021.
  6. Goodwin J., Colver A., Basu A., Crombie S., Howel D. et al. Understanding frames: A UK survey of parents and professionals regarding the use of standing frames for children with cerebral palsy. Child Care Health Dev. 2018;44(2):195-202. doi: 10.1111/cch.12505.
  7. Winter S. Cerebral Palsy. In: Rubin I.L., Merrick J., Greydanus D.E., Patel D.R. (eds). Health Care for People with Intellectual and Developmental Disabilities across the Lifespan. Switzerland: Springer; 2016. doi: 10.1007/978-3-319-18096-0_80.
  8. Cauraugh J.H., Naik S.K., Hsu W.H., Coombes S.A., Holt K.G. Children with cerebral palsy: a systematic review and meta-analysis on gait and electrical stimulation. Clin Rehabil. 2010;24(11):963-978.
  9. Julieanne P.S., Freeman M. Overview of foot deformity management in children with cerebral palsy. J Child Orthop. 2013;7(5):373-377. doi: 10.1007/s11832-013-0509-4.
  10. Kirby R.S., Wingate M.S., Van Naarden B.K., Doernberg N.S., Arneson C.L., Benedict R.E. et al. Prevalence and functioning of children with cerebral palsy in four areas of the United States in 2006: a report from the Autism and developmental disabilities monitoring network. Res Dev Disabil. 2011;32(2):462-469.
  11. Клочкова О.А., Куренков А.Л., Кенис В.М. Формирование контрактур при спастических формах детского церебрального паралича: вопросы патогенеза. Ортопедия, травматология и восстановительная хирургия детского возраста. 2018;6(1): 58-66. doi: 10.17816/PTORS6158-66.
  12. Solopova I.A., Moshonkina T.R., Umnov V.V., Vissarionov S.V., Baindurashvili A. G., Gerasimenko Yu.P. Neurorehabilitation of patients with cerebral palsy. Human Physiology. 2015;41(4):448-454.
  13. Munger M.E., Chen B.P., MacWilliams B.A., McMulkin M.L., Schwartz M.H. Comparing the effects of two spasticity management strategies on the long-term outcomes of individuals with bilateral spastic cerebral palsy: a multicentre cohort study protocol. BMJ Open. 2019;9(6):e027486. doi: 10.1136/bmjopen-2018-027486.
  14. Кенис В.М. Лечение динамических эквино-плано-вальгусных деформаций стоп у детей с ДЦП. Вестник Северо-Западного государственного медицинского университета им. И.И. Мечникова. 2012;4(1): 35-40.
  15. Рыжиков Д.В. Оперативное лечение эквино-плоско-вальгусной деформации стоп у детей больных детским церебральным параличом. Гений ортопедии. 2010;(3):95-100.
  16. Choi J.Y., Jung S., Rha D.W., Park E.S. Botulinum toxin type A injection for spastic equinovarus foot in children with cerebral palsy: effects on gait and foot pressure distribution. Yonsei Med J. 2016;57(2):496-504. doi: 10.3349/ymj.2016.57.2.496.
  17. Galli M., Cimolin V., Pau M., Leban B., Brunner R., Albertini G. Foot pressure distribution in children with cerebral palsy while standing. Res Dev Disabil. 2015; 41-42:52-57. doi: 10.1016/j.ridd.2015.05.006.
  18. Kedem P., Scher D.M. Foot deformities in children with cerebral palsy. Curr Opin Pediatr. 2015;27(1):67-74. doi: 10.1097/MOP.0000000000000180.
  19. Wen J., Liu H., Xiao S., Li X., Fang K., Zeng M. et al. Comparison of mid-term efficacy of spastic flatfoot in ambulant children with cerebral palsy by 2 different methods. Medicine (Baltimore). 2017;96(22):e7044. doi: 10.1097/MD.0000000000007044.
  20. Сычевский Л.З., Аносов В.С., Мармыш А.Г. Динамическая фотоплантография в диагностике деформаций стопы при детском церебральном параличе. Журнал Гродненского государственного медицинского университета. 2010;2:51-53.
  21. Karamitopoulos M.S., Nirenstein L. Neuromuscular foot: spastic cerebral palsy. Foot Ankle Clin. 2015;20(4):657-668. doi: 10.1016/j.fcl.2015.07.008.
  22. Miller F. Foot Deformities Impact on Cerebral Palsy Gait. In: Cerebral Palsy. 2018. doi: 10.1007/978-3-319-50592-3_201-1.
  23. Smirnova L.M. Hardware–Software Complex for Assessment of Anatomic–Functional Disturbances and Orthesis Efficiency in Patients with Foot Pathology. Biomed Eng. 2009;43(6):260-264. doi: 10.1007/s10527-010-9137-1.
  24. Palisano R., Rosenbaum P., Walter S., Russell D., Wood E., Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-223.
  25. Chen W., Yao J., Yang Y., Liu X., Wang L., Pu F., Fan Y. Relationship between subtalar joint stiffness and relaxed calcaneal stance position in cerebral palsy children with valgus deformities. BioMed Res Int. 2018;(2018):1-10. doi: 10.1155/2018/6576108.
  26. Умнов В.В., Умнов Д.В. Особенности патогенеза, клиники и диагностики эквино-плано-вальгусной деформации стоп у больных детским церебральным параличом. Травматология и ортопедия России. 2013;(1):93-98. doi: 10.21823/2311-2905-2013—1-93-98.
  27. Boulay C., Jacquemier M., Castanier E., Giorgi H., Authier G., Pomero V. et al. Planovalgus foot deformity in cerebral palsy corrected by botulinum toxin injection in the peroneus longus: Clinical and radiological evaluations in young children. Ann Phys Rehabil Med. 2015;58(6):316-321. doi: 10.1016/j.rehab.2015.09.001.
  28. van de Velde S.K., Cashin M., Johari R., Blackshaw R., Khot A., Graham H.K. Symptomatic hallux valgus and dorsal bunion in adolescents with cerebral palsy: clinical and biomechanical factors. Dev Med Child Neurol. 2018;60(6):624-628. doi: 10.1111/dmcn.13724.
  29. Клочкова О.А., Куренков А.Л. Выбор целей и приоритетов ботулинотерапии у пациентов с детским церебральным параличом. Журнал неврологии и психиатрии им. С.С. Корсакова. 2019;(2):118-124. doi: 10.17116/jnevro2019119021118.
  30. Church C., Lennon N., Alton R., Schwartz J., Niiler T., Henley J., Miller F. Longitudinal change in foot posture in children with cerebral palsy. J Child Orthop. 2017;11(3):229-236. doi: 10.1302/1863-2548.11.160197.



Abstract: 517


CrossRef: 1

  1. Smirnova LM, Dzhomardly EI, Koltsov AA. The Interzonal Distribution of the Load on the Plantar Surface of the Foot During Walking in the Patients with Cerebral Palsy as an Objective Criterion of Functional Impairment Severity. Traumatology and Orthopedics of Russia. 2020;26(3):80. doi: 10.21823/2311-2905-2020-26-3-80-92


Article Metrics

Metrics Loading ...


Copyright (c)

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies