Ertuğrul AKŞAHİN, H. Yalçın YÜKSEL, MELEK GÜNEŞ YAVUZER, Hasan Hilmi MURATLI, Levent ÇELEBİ, Ali BİÇİMOĞLU

Tek taraflı pes ekinovarus cerrahisi ile başarılı sonuç alınmış çocukların niceliksel yürüme özellikleri

Amac: Bu çalışmada tek taraşı pes ekinovarus (PEV) nedeniyle ameliyat edilen, klinik ve semptomatik değerlendirmelere göre sonuçları iyi olan hastaların fonksiyonel sonuçlarının yürüme analizi yöntemleri kullanılarak değerlendirilmesi ve bu sonuçların karşı taraf sağlıklı ekstremiteleri ve sağlıklı çocukların bulgularıyla karşılaştırarak normalden sapma ve kompanzasyon özelliklerinin araştırılması amaçlanmıştır. Calışma planı: Tek taraşı PEV nedeniyle cerrahi tedavi uygulanmış 16 çocuk [10 erkek, 6 kız; ortalama yaş, 6.8 (dağılım 4-9)] ve yaş uyumlu 24 sağlıklı çocuk çalışmaya dahil edildi. Ayak uzunluğu, baldır çapı, ayak bileği hareket aralığı ve radyografik ölçümler kaydedildi. Zamanuzaklı k (yürüme hızı, tempo, adım zamanı, adım uzunluğu, çift destek zamanı), kinematik (sagittal, koronal, transvers planda pelvis, kalça, diz ve ayak bileği eklem hareket açıları) ve kinetik (yer reaksiyon kuvvetleri, diz, ayak bileği, kalçanın momentleri ve güçleri) verileri değerlendirildi. Sonuclar: Etkilenen ekstremitenin baldır çapları, ayak bileği hareket genişlikleri karşı normal taraftan azdı (p

Quantitative gait characteristics of children who had successful unilateral clubfoot operation

Objectives: In this study, we aimed to evaluate the functional results of patients operated for unilateral clubfoot who had good clinical outcome with gait analysis. We also investigated the deviation from the normal, and determined the compensation mechanisms by comparing this data with the unaffected feet and with the feet of healthy children. Methods: Sixteen children [10 boys, 6 girls; mean age, 6.8 years (range 4-9 years)] with surgically treated unilateral clubfoot and 24 age-matched healthy children were included in the study. Foot length, calf circumference, ankle range of motion, and radiographic measurements were recorded. All time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee, and ankle in sagittal, coronal and transverse planes), and kinetic (ground reaction forces, moments, and powers of hip, knee, and ankle) data were evaluated. Results: Calf circumference and ankle range of motion of involved extremity were significantly less than the unaffected side (p<0.05). Quantitative gait data revealed that children with clubfoot had slower walking velocity (0.75±0.25 m/sec vs. 1.02±0.18 m/sec, p=0.01), shorter stride length (0.72±0.23 m vs. 0.91±0.05 m, p=0.01) than healthy children group. Affected foot of unilateral clubfoot patients had more toe-in than healthy children (-14.24±21.78° vs. 18.54±7.90°, p=0.001). Unaffected side showed increased pelvic excursions and medio-lateral ground reaction forces as well as decreased ankle and hip motion in sagittal plane. Conclusion: Even asymptomatic well-treated children with unilateral clubfoot may have gait deviations both in the affected and unaffected sides. These alterations may also be the result of the subclinical involvement of the so called healthy foot by disease (clubfoot) as well as the compensatory mechanisms.

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