title: Analysis of foot and ankle disorders and prediction of gait in multiple sclerosis rehabilitation.
abstract: BACKGROUND
  Multiple sclerosis (MS) is a disease of the central nervous system probably based on the autoimmune mechanism against myelin and the action of lymphocyte T. In the last 50 years, more than 150 descriptive studies regarding MS have focused on the etiopathogeny, treatment, diagnosis and prevention of the progressive evolution of MS. Most recently, studies in the field of rehabilitation and diagnosis have tried to present the postural aspects of control/foot and ankle control and gait pattern in MS. The aim of this study is focused on biomechanical foot analyses of MS patients.
  
  
  METHODS
  Our clinical research and functional assessment was based on a scale like the EDSS/Kurtzke score: biomechanical foot assessment used the RSscan force plate to assess the foot loading, impulse and foot-ankle angle (subtalar angle), and pressure distribution methods for statistical analyses. The study included MS patients at the Neurologic Rehabilitation Unit, Craiova, we studied 48 patients (46.04 ± 10.99 years) diagnosed with MS.
  
  
  RESULTS
  This study shows that the major lesion is to the pyramidal system and the average value for functionality index (EDSS score) is 3.03 ± 0.13, where 3 means easy paraparesis or hemiparesis. In considering postural strategies, we observed an instability left to right to be more evident in the swing phase and it influences the under the foot impulse for the next step and postural control. From the analysis of the data and pressure centre position, we can see that the high pressure is on metatarsian II to III and more or less at the heel. This means the development of an ankle strategy necessary to restore balance, stability and motor control cannot be assessed other than by clinical evaluation. Even if many physicians and physical therapists do use the functional scale in their daily assessment, it does not help us achieve a complex assessment of gait and lower limb behaviour during gait, nor does it provide information about the impact of gait on daily activities and on quality of life.
  
  
  CONCLUSIONS
  Biomechanical assessment can help the clinician predict the functional evolution of MS patients without visible clinical gait disorders and allows the development of a strategy for rehabilitation to prevent an incorrect ankle/ankle and foot position, resulting in a lack of motor control.
authors.affiliation: Sports Medicine and Kinesiology Department, University of Craiova, Srada Alexandru Ioan Cuza 13, Craiova, 200585, Romania. ligiarusu@hotmail.com.
authors.forename: Ligia
authors.initials: L
authors.lastname: Rusu
authors.affiliation: Department of Pathologic Physiology, University of Medicine and Pharmacy of Craiova, Strada Petru Rareş 2-4, Craiova, 200349, Romania. drcristianneamtu@yahoo.com.
authors.forename: Marius Cristian
authors.initials: MC
authors.lastname: Neamtu
authors.affiliation: Sports Medicine and Kinesiology Department, University of Craiova, Srada Alexandru Ioan Cuza 13, Craiova, 200585, Romania. erosulescu@yahoo.com.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Rosulescu
authors.affiliation: Department of Theory and Methodology of Motricity Activities, University of Craiova, Strada Alexandru Ioan Cuza 13, Craiova, 200585, Romania. germinacosma@yahoo.com.
authors.forename: Germina
authors.initials: G
authors.lastname: Cosma
authors.affiliation: Sports Medicine and Kinesiology Department, University of Craiova, Srada Alexandru Ioan Cuza 13, Craiova, 200585, Romania. special_dmm@yahoo.com.
authors.forename: Mihai
authors.initials: M
authors.lastname: Dragomir
authors.affiliation: Department of Applied Mechanics, University of Craiova, Strada Alexandru Ioan Cuza 13, Craiova, 200585, Romania. mihnea_marin@yahoo.com.
authors.forename: Mihnea Ion
authors.initials: MI
authors.lastname: Marin
mesh_terms: D000328:Adult; D000842:Ankle / Q000503:physiopathology*; D000843:Ankle Joint / Q000503:physiopathology*; D001696:Biomechanical Phenomena / Q000502:physiology; D005260:Female; D005528:Foot / Q000503:physiopathology*; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000534:rehabilitation*