Comparison of Pes Echinovarus Patients and Healthy Children in Terms of Pedobarographic and Ankle Biomechanics
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2023
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Bu çalışmada, PEV nedeniyle tedavi edilen hastaların; klinik, pedobarografik ve kas gücü ölçüm sonuçlarını değerlendirmesi ve kontrol grubu ile karşılaştırılması amaçlandı. Hastalar ve Yöntemler: Tek taraflı veya çift taraflı Ponseti tekniği ile tedavi edilip aşilotomi yapılan hastalar ile nüks PEV nedeni ile ameliyat edilen 3-10 yaş arasındaki toplam 52 hasta çalışmaya dahil edildi. Alt ekstremitesinde patolojisi olmayan, üst ektremite patolojisi nedeni ile ortopedi polikliniğine başvuran 3-10 yaş arasındaki çocukların ayakları kontrol grubu olarak belirlendi. Çalışmaya alınan bütün çocuklar yaş aralığına göre 3 gruba ayırıldı: 3-5 yaş arası grup A, 6-7 yaş arası grup B ve 8-10 yaş arası grup C olarak belirlendi. Hastaların tedavi sonuçlarının klinik değerlendirilmesi Dimeglio- Bensahel ve İCFSG skalasına göre yapıldı. Kas gücü ölçümleri manuel dinamometre ile, ayak bası analizi pedobarografi ile değerlendirildi. Alınan ölçümler üzerinde istatistiksel karşılaştırmalar ve korelasyon analizleri yapıldı. Bulgular: Tek taraflı tutulumu olan hastaların ayak bileği çevresi kas kuvveti ölçüm sonuçları incelendiğinde dorsifleksiyon, plantarfleksiyon, eversiyon ve inversiyon yönünde tutulum olan tarafın kas kuvvetinin sağlam tarafa göre istatistiksel açıdan anlamlıydı (p<0,002, p<0,005, p<0,0095, p<0,0025). Hem etkilenmiş ve etkilenmemiş tarafların kontrol grubu ile karşılaştırılmasında plantar fleksiyon ve inversiyonda istatistiksel anlamlıydı düzeyde zayıf görüldü. Bilateral PEV hastalarının kas küvveti olçümü kontrol grubuna göre istatistiksel olarak anlamlı derecede düşük bulundu (p<0001). Tek taraflı PEV hastalarının pedobarografik değerlendirilmesinde, etkilenmiş tarafın etkilenmemiş tarafa göre lateral orta ayak bölgesine fazla bastığı ve medial ön ayak bölgesine basamadığı görüldü. Etkilenmiş tarafın kontrol grubuna göre topuk bölgesine (p<0001), medial orta ayak (p<0002) ve medial ön ayak bölgesine (p<0001) zayıf bastığı görüldü. Etkilenmemiş tarafın kontrol grubuna göre karşılaştırılmasında medial orta ayağa anlamlı derecede fazla bastığı (p<0,0033) görüldü. Bilateral PEV hastalarının tek taraflı PEV hastalarına göre pedobarografik değerlendirilmesinde, topuk ve lateral orta ayak bölgesine anlamlı düzeyde fazla bastığı görüldü. Çıkarımlar: PEV'li hastaların takibinde hastaların pedobarografik ve kas kuvveti olarak değerlendirilmesi erken nüksleri önleyebilir. Unilateral PEV'li hastaların yalnızca tutulan ayakları vi değil etkilenmemiş ayaklarını takip etmek gelişebilecek Pes planus deformitesinin erken tespiti açısından faydalı olabilir. Tibialis anterior tendon transferi ayak bileği dorsifleksiyon kas kuvveti açısından düşünülenin aksine daha masum bir teknik olabilir. PEV tedavisinde sıklıkla kullanılan aşiloplasti ve posteromedial gevşetme müdahalelerinin, plantar fleksiyon kas gücü kaybına yol açması nedeniyle hastaların uzun süre fizik tedavi uygulamalarına katılmalarını ve yakın takipte tutulmalarını önermekteyiz. PEV'li hastalarda pedobarografik ölçümde, basınç alanlarının az olduğu bölgeleri destekleyen tabanlık kullanımının deformiteyi arttıracağını düşünüyoruz.
In this study, ıt was aimed to evaluate the clinical, pedobarographic and muscle strength measurement results of patients treated for clubfoot and to compare them with the control group. Patients and Methods: A total of 52 patients aged 3-10 years who were treated with unilateral or bilateral Ponseti technique and underwent achillotomy and operated for recurrent clubfoot were included in the study. The children aged 3-10 years, who had no pathology in their lower extremities and who applied to the orthopedics outpatient clinic due to upper extremity pathology, were determined as the control group. Children included in the study were divided into 3 groups according to age range: Those between the age of 3-5 named group A, between the age of 6-7 named group B. between the age of 8-10 named group C. Clinical evaluation of treatment results of the patients were made according to Dimeglio- Bensahel and ICFSG scale. The measurements of muscle strength were evaluated with a manuel dynamometer, foot pressure analysis was evaluated with pedobarography. Statistical comparisons and correlation analyses were performed on the measurements obtained. Evidence: When the measurements of strength of muscles around the ankle of patients with unilateral involvement were examined a statistically significant difference was found between the muscle strength of the affected side in dorsiflexion, plantarflexion, eversion and inversion and the muscle strength of the healthy side. (p<0,002, p<0,005, p<0,0095, p<0,0025). Both the affected and unaffected feet of the PEV patients were compared with the control group. It was observed that vii the feet of the patients were statistically weak in plantar flexion and inversion. The muscle strength of the patients with bilateral PEV was found to be statistically significantly weaker than the control group. (p<0001).In pedobarographic evaluation of unilateral clubfoot patients it was observed that the affected side stepped on the lateral midfoot area more than affected side and could not step on the medial forefoot area. It was observed that the affected side had weak footing on the heel area (p<0001), medial midfoot (p<0002) and medial forefoot area (p<0001) when compared to the control group and the unaffected side stepped on the medial midfoot significantly more than the control group (p<0.0033). In the pedobarographic evaluation of bilateral clubfoot patients compared to unilateral clubfoot patients, it was observed that bilateral clubfoot patients pressed more signifacantly the heel and lateral midfoot area. Results: Pedobarographic and muscle strength evaluation of patients in the follow-up of patients with clubfoot may prevent early recurrences. It may be useful to follow up not only affected side but unaffected side of patients with unilateral clubfoot, in terms of early detection of pes planus deformity that may develop. Tibialis anterior tendon transfer may be a more innocent technique contrary to what is thought in terms of ankle dorsiflexion muscle strength. We recommend that patients participate in physical therapy for a long time and be followed up closely, since achille tendon operation and posteromedial release interventions, which are frequently used in clubfoot treatment, cause loss of plantar flexion muscle strength. We think that the use of insoles that support low pressure areas will increase deformity in pedobarographic measurement in patients with clubfoot
In this study, ıt was aimed to evaluate the clinical, pedobarographic and muscle strength measurement results of patients treated for clubfoot and to compare them with the control group. Patients and Methods: A total of 52 patients aged 3-10 years who were treated with unilateral or bilateral Ponseti technique and underwent achillotomy and operated for recurrent clubfoot were included in the study. The children aged 3-10 years, who had no pathology in their lower extremities and who applied to the orthopedics outpatient clinic due to upper extremity pathology, were determined as the control group. Children included in the study were divided into 3 groups according to age range: Those between the age of 3-5 named group A, between the age of 6-7 named group B. between the age of 8-10 named group C. Clinical evaluation of treatment results of the patients were made according to Dimeglio- Bensahel and ICFSG scale. The measurements of muscle strength were evaluated with a manuel dynamometer, foot pressure analysis was evaluated with pedobarography. Statistical comparisons and correlation analyses were performed on the measurements obtained. Evidence: When the measurements of strength of muscles around the ankle of patients with unilateral involvement were examined a statistically significant difference was found between the muscle strength of the affected side in dorsiflexion, plantarflexion, eversion and inversion and the muscle strength of the healthy side. (p<0,002, p<0,005, p<0,0095, p<0,0025). Both the affected and unaffected feet of the PEV patients were compared with the control group. It was observed that vii the feet of the patients were statistically weak in plantar flexion and inversion. The muscle strength of the patients with bilateral PEV was found to be statistically significantly weaker than the control group. (p<0001).In pedobarographic evaluation of unilateral clubfoot patients it was observed that the affected side stepped on the lateral midfoot area more than affected side and could not step on the medial forefoot area. It was observed that the affected side had weak footing on the heel area (p<0001), medial midfoot (p<0002) and medial forefoot area (p<0001) when compared to the control group and the unaffected side stepped on the medial midfoot significantly more than the control group (p<0.0033). In the pedobarographic evaluation of bilateral clubfoot patients compared to unilateral clubfoot patients, it was observed that bilateral clubfoot patients pressed more signifacantly the heel and lateral midfoot area. Results: Pedobarographic and muscle strength evaluation of patients in the follow-up of patients with clubfoot may prevent early recurrences. It may be useful to follow up not only affected side but unaffected side of patients with unilateral clubfoot, in terms of early detection of pes planus deformity that may develop. Tibialis anterior tendon transfer may be a more innocent technique contrary to what is thought in terms of ankle dorsiflexion muscle strength. We recommend that patients participate in physical therapy for a long time and be followed up closely, since achille tendon operation and posteromedial release interventions, which are frequently used in clubfoot treatment, cause loss of plantar flexion muscle strength. We think that the use of insoles that support low pressure areas will increase deformity in pedobarographic measurement in patients with clubfoot
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Ortopedi ve Travmatoloji, Ortopedi, Orthopedics and Traumatology, Orthopedics
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