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

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Relevance. The main direction of rehabilitation of children with cerebral palsy is the preservation and enhancement of the existing level of support and locomotion, as well as compensation of its impairment through various methods of rehabilitation. For an adequate prescription and reliable assessment of these measures effectiveness, it is necessary to use objective indicators of functional impairment characteristic of cerebral palsy. The purpose of this study was to substantiate objective biomechanical indicators of functional impairment in children with cerebral palsy based on the analysis of the interzonal distribution of the load on the foot during walking, taking into account the level of global motor functions impairment. Materials and Methods. 47 children with cerebral palsy at the GMFCS levels of impairment 1 to 3 were examined. The control group consisted of 14 children without anatomical and functional signs of support and locomotion system impairment. Biomechanical examination was performed on the complex «DiaSled-M-Scan» with matrix plantar pressure meters in the form of insoles. The statistical analysis of the data was carried out by nonparametric methods using the SPSS for Widows software. Results. The analysis of the anatomical and functional impairment of 94 feet of the children with cerebral palsy and 28 feet of the control group revealed differences in the interzonal distribution of the load under the feet in six variables (p from <0.001 to 0.003). The most typical were: an increase in the toe-to-heel load ratio (on average by 80%), an increase in the load on the arch (by 49%), and a decrease in the medio-lateral load ratio on the toe (by 37%). For GMFCS 1 patients, a significant indicator of impairment was an increase in the partial load on the arch, for GMFCS 2 and 3 patients — a decrease in the load on the heel and an increase it under the toe. This leads to an increase in the toe-to-heel load ratio. Conclusion. It is advisable to use the revealed indicators of roll-over-the-foot impairment in the functional diagnosis of the condition and in assessing the effectiveness of rehabilitation of children with cerebral palsy.

About the authors

L. M. Smirnova

Federal Scientific Centre of Rehabilitation of the Disabled named after G.A. Albrecht; St. Petersburg State Electrotechnical University “LETI”

Author for correspondence.
ORCID iD: 0000-0003-4373-9342

Liudmila M. Smirnova — Dr. Sci. (Tech.), Leading Researcher, Department of Biomechanical Researches of Musculoskeletal System, Federal Scientific Centre of Rehabilitation of the Disabled named after G.A. Albrecht; Profeccor of Biotechnical Systems Department, St. Petersburg State Electrotechnical University “LETI”

St. Petersburg

Russian Federation

E. I. Dzhomardly

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

ORCID iD: 0000-0002-0281-3262

Elnur I. Dzomardly — Orthopedic Surgeon, PhD Student

St. Petersburg

Russian Federation

A. A. Koltsov

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

ORCID iD: 0000-0002-0862-8826

Andrey A. Koltsov — Cand. Sci. (Med.), Chief of Orthopedic Department for Children

St. Petersburg

Russian Federation


  1. Valentina J., Davidson S.A., Bear N., Blair E., Paterson L., Ward R. et al. A prospective study investigating gross motor function of children with cerebral palsy and GMFCS level II after long-term botulinum toxin type A use. BMC Pediatrics. 2020;20(1):7. doi: 10.1186/s12887-019-1906-8.
  2. Collado-Garrido L., Paras-Bravo P., Calvo-Martin P., Santibanez-Marguello M. Impact of resistance therapy on motor function in children with cerebral palsy: A systematic review and meta-analysis. Int J Environ Res Public Health. 2019;16(22):e4513. doi: 10.3390/ijerph16224513.
  3. Domagalska-Szopa M., Szopa A. Gait pattern differences among children with bilateral cerebral palsy. Front Neurol. 2019;10(183):1-7. doi: 10.3389/fneur.2019.00183.
  4. Zhou J., Butler E.E., Rose J. Neurologic correlates of gait abnormalities in cerebral palsy: Implications for treatment. Front Hum Neurosci. 2017;11(103):1-20. doi: 10.3389/fnhum.2017.00103.
  5. Кенис В.М. Лечение динамических эквино-плановальгусных деформаций стоп у детей с ДЦП. Вестник Северо-Западного государственного медицинского университета им. И.И. Мечникова. 2012;4(1):35-40.
  6. 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;4142:52-57. doi: 10.1016/j.ridd.2015.05.006.
  7. 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.
  8. Munger M.E., Chen B.P.J., 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:e027486. doi: 10.1136/bmjopen-2018-027486.
  9. Falisse A., Bar-On L., Desloovere K., Jonkers I., De Groote F. A spasticity model based on feedback from muscle force explains muscle activity during passive stretches and gait in children with cerebral palsy. PLoS. 2018;13(12):e0208811. doi: 10.1371/journal.pone.0208811.
  10. Armand S,. Decoulon G., Bonnefoy-Mazure A. Gait analysis in children with cerebral palsy. EFFORT Open Rev. 2016;1(12):448-460. doi: 10.1302/2058-5241.1.000052.
  11. Sees J.P., Miller F. Overview of foot deformity management in children with cerebral palsy. J Child Orthop. 2013;7:373-377. doi: 10.1007/s11832-013-0509-4.
  12. 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. doi: 10.1111/j.1469-8749.1997.tb07414.x.
  13. Wang K.K., Munger M.E., Chen B.P.-J., Novacheck T.F. Selective dorsal rhizotomy in ambulant children with cerebral palsy. J Child Orthop. 2018;12:413-427. doi: 10.1302/18632548.12.180123.
  14. Gulati S., Sondhi V. Cerebral Palsy: An Overview. Indian J Pediatr. 2018;85(11):1006-1016. doi: 10.1007/s12098-017-2475-1.
  15. Meyns P., Kerkum y.L., Brehm M.A., Becher J.G., Buizer A.I., Harlaar J. Ankle foot orthoses in cerebral palsy: Effects of ankle stiffness on trunk kinematics, gait stability and energy cost of walking. Eur J Paediatr Neurol. 2020; 26: 68-74. doi: 10.1016/j.ejpn.2020.02.009.
  16. Смирнова Л.М., Джомардлы э.И., Кольцов А.А., Объективные признаки деформаций стоп у детей со спастическими формами детского церебрального паралича: обоснование индивидуального подхода к обеспечению обувью. Травматология и ортопедия России. 2019;25(3):90-99. (In Russia). doi: 10.21823/2311-2905-2019-25-3-90-99.
  17. Chen W., Liu x., Pu F., yang y., Wang L., Liu H., Fan y. Conservative treatment for equinus deformity in children with cerebral palsy using an adjustable splint assisted ankle-foot orthosis. Medicine (Baltimore). 2017;96(40):e8186. doi: 10.1097/MD.0000000000008186.
  18. Gendy S., Elgebeily M., El-Sobky T.A., Khoshhal K.I., Jawadi A.H. Current practice and preferences to management of equinus in children with cerebral palsy: A survey of orthopedic surgeons. SICOT J. 2019;5(3):1-8. doi: 10.1051/sicotj/2019003
  19. Park K.B., Joo S.y., Park H., Rhee I., Shin J.K., Abdel-Baki S.W., Kim H.W. Architecture of the triceps surae muscles complex in patients with spastic hemiplegia: implication for the limited utility of the silfverskiold test. J Clin Med. 2019;(8):e2096. doi: 10.3390/jcm8122096
  20. Rethlefsen S.A., Blumstein G., Kay R.M., Dorey F., Wren T.A.L. Prevalence of specific gait abnormalities in children with cerebral palsy revisited: influence of age, prior surgery, and gross motor function classification system level. Dev Med Child Neurol. 2017;59(1):79-88. doi: 10.1111/dmcn.13205.
  21. Park B.S., Chung C.y., Park M.S., Lee K.M., Cho S.H., Sung K.H. Effects of soft tissue surgery on transverse kinematics in patients with cerebral palsy. BMC Musculoskelet Disord. 2019;20(1):566. doi: 10.1186/s12891-019-2955-8.
  22. Kim H.y., Cha y.H., Byun J.y., Chun y.S., Choy W.S. Changes in gait parameters after femoral derotational osteotomy in cerebral palsy patients with medial femoral torsion. Journal of Pediatric Orthopaedics B. 2018;27:194-199. doi: 10.1097/BPB.0000000000000467.
  23. Saglam y., Akalan N.E., Temelii y., Kuchimov S. Femoral derotation osteotomy with multi-level soft tissue procedures in children with cerebral palsy: does it improve gait quality. J Child Orthop. 2016;10(1):41-48. doi: 10.1007/s11832-015-0706-4.
  24. Lee K.M., Chung C.y., Sung K.H., Kim T.W., Lee S.y., Park M.S. Femoral anterversion and torsion only explain 25% of variance in regression analysis of foot progression angle in children with diplegic cerebral palsy. J Neuroeng Rehabil. 2013;10:56. doi: 10.1186/1743-0003-10-56.
  25. Carty C.P., Walsh H.P.J., Gillett J.G., Phillips T., Edwards J.M., deLacy M., Boyd R.N. The effect of femoral derotation osteotomy on transverse plane hip and pelvic kinematics in children with cerebral palsy: A systematic review and meta-analysis. Gait Posture. 2014;40(3): 333-340. doi: 10.1016/j.gaitpost.2014.05.06.
  26. Shuman B.R., Goudriaan M., Desloovere K., Schwatz M.H., Steele K.M. Muscle synergies demonstrate only minimal changes after treatment in cerebral palsy. J Neuroeng Rehabil. 2019;16(46):2-7. doi: 10.1186/s12984-019-0502-3.
  27. Barret R.S., Lichtwark G.A. Gross muscle morphology and structure in spastic cerebral palsy: systematic review. Development Medicine and Child Neurology. 2010;52(9):794-804. doi: 10.1111/j.1469-8749.2010.03686.x
  28. Choe yR, Kim JS, Kim KH, yi TI. Relationship between functional level and muscle thickness in young children with cerebral palsy. Ann Rehabil Med. 2018;42(2):286-295. doi: 10.5535/arm.2018.42.2.286.
  29. Mutlu A., Pistav-Akmese P., yardimci B.N., Ogretmen T. What do the relationships between functional classification systems of children with cerebral palsy tell us? J Phys Sci. 2016;28:3493-3498. doi: 10.1589/jpts.28.3493.
  30. Cobanoglu M., Cullu E., Omurlu I. The effect of hip reconstruction on gross motor function levels in children with cerebral palsy. Acta Orthop Traumatol Turc. 2018;52(1):44-48. doi: 10.1016/j.aott.2017.11.001.

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