title: Segmental kinematic analysis of planovalgus feet during walking in children with cerebral palsy.
abstract: Pes planovalgus (flatfoot) is a common deformity among children with cerebral palsy. The Milwaukee Foot Model (MFM), a multi-segmental kinematic foot model, which uses radiography to align the underlying bony anatomy with reflective surface markers, was used to evaluate 20 pediatric participants (30feet) with planovalgus secondary to cerebral palsy prior to surgery. Three-dimensional kinematics of the tibia, hindfoot, forefoot, and hallux segments are reported and compared to an age-matched control set of typically-developing children. Most results were consistent with known characteristics of the deformity and showed decreased plantar flexion of the forefoot relative to hindfoot, increased forefoot abduction, and decreased ranges of motion during push-off in the planovalgus group. Interestingly, while forefoot characteristics were uniformly distributed in a common direction in the transverse plane, there was marked variability of forefoot and hindfoot coronal plane and hindfoot transverse plane positioning. The key finding of these data was the radiographic indexing of the MFM was able to show flat feet in cerebral palsy do not always demonstrate more hindfoot eversion than the typically-developing hindfoot. The coronal plane kinematics of the hindfoot show cases planovalgus feet with the hindfoot in inversion, eversion, and neutral. Along with other metrics, the MFM can be a valuable tool for monitoring kinematic deformity, facilitating clinical decision making, and providing a quantitative analysis of surgical effects on the planovalgus foot.
authors.affiliation: Marquette University, P.O. Box 1881, Milwaukee, WI 53201, USA. Electronic address: karen.kruger@marquette.edu.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kruger
authors.affiliation: Marquette University, P.O. Box 1881, Milwaukee, WI 53201, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Konop
authors.affiliation: Shriners Hospitals for Children - Chicago, 2211 N Oak Park Ave., Chicago, IL 60707, USA; Midwestern University, Physical Therapy Program, 555 31st St., Downers Grove, IL 60515, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Krzak
authors.affiliation: Shriners Hospitals for Children - Chicago, 2211 N Oak Park Ave., Chicago, IL 60707, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Graf
authors.affiliation: Shriners Hospitals for Children - Chicago, 2211 N Oak Park Ave., Chicago, IL 60707, USA.
authors.forename: Haluk
authors.initials: H
authors.lastname: Altiok
authors.affiliation: Shriners Hospitals for Children - Chicago, 2211 N Oak Park Ave., Chicago, IL 60707, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Smith
authors.affiliation: Marquette University, P.O. Box 1881, Milwaukee, WI 53201, USA; Shriners Hospitals for Children - Chicago, 2211 N Oak Park Ave., Chicago, IL 60707, USA.
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D002648:Child; D005260:Female; D005413:Flatfoot / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D005528:Foot / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D011859:Radiography; D016138:Walking / Q000502:physiology*
keywords: Cerebral palsy; Foot; Gait; Model; Pediatric; Planovalgus