The influence of optimal ankle dorsiflexion angle prediction on the gait of children with cerebral palsy after Achilles tendon lengthening surgery for equinus foot deformity
10.3760/cma.j.issn.0254-1424.2024.10.011
- VernacularTitle:踝关节最佳背屈角度的预测对脑性瘫痪儿童马蹄足畸形跟腱延长手术后步态的影响
- Author:
Rufa WANG
1
;
Pengfei ZHENG
;
Yue LOU
;
Xiaoguang ZHOU
Author Information
1. 南京医科大学附属儿童医院骨科，南京 210000
- Keywords:
Cerebral palsy;
Equinus;
Achilles tendon lengthening;
Gait analysis
- From:
Chinese Journal of Physical Medicine and Rehabilitation
2024;46(10):923-928
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To observe any effect of ankle dorsiflexion angle on the gait of children with cerebral palsy (CP) after Achilles tendon lengthening surgery.Methods:Nine children with CP and equinus foot deformity were given Achilles tendon lengthening surgery. Reconstruction images of their pelvises and lower limbs were collected before the surgery and used to construct OpenSim simulations. Gait analysis data were also recorded before the surgery. The curve of changes to the Achilles tendon insertion was simulated in the software to determine the optimum angle of ankle dorsiflexion, and that guided the Achilles tendon extension surgery. The 3D gait analysis was repeated 12 months after the surgery to compare the spatiotemporal, kinematic and dynamic parameters (especially maximum ground reaction force on the affected side). The maximum dorsiflexion angles of the ankle joint before and after surgery were also recorded.Results:Before the surgery the dorsiflexion angles ranged from 8 to 12°, with an average of (10.1±1.2)°. After the surgery, significant changes were observed in the stride length, rhythm, speed and stride time of the affected side, as well as the maximum forward angle of the supported pelvis, the maximum dorsiflexion angle of the supported ankle and the maximum plantar flexion angle of the swinging ankle. Twelve months after the surgery, no recurrence of horseshoe malformation or over-correction complications were found in any of the 9 patients.Conclusions:3D gait analysis technology combined with OpenSim software can simulate the changes in Achilles tendon length needed by children with cerebral palsy. The optimum ankle dorsiflexion angle can be predicted pre-operatively and the simulation can also guide the operation. This technique also offers pre-and post-operative quantitative evaluation to provide references for subsequent rehabilitation treatment.
