Cerebral palsy (CP) is a neurological condition that affects musculoskeletal system causing altered balance control, which is governed by constant adjustments by muscular activity and joint positioning. Since the foot is the platform upon which we stand and balance, it is important to study and characterize foot posture abnormalities in CP to better understand their possible effect on multidirectional limits of stability (MDLS) in standing. Our aim was to find relation between foot posture and MDLS in diplegic children. Thirty diplegics (13 pes-planus and 17 pes-cavus) between the age of 6 to 14, gross motor function classification system (GMFCS) levels I and II, whose parents consented were included in this study. Diplegics unable to stand unsupported for < 2 minutes, undergone lower-limb surgeries in 6 months, having visual impairments were excluded. Foot posture was assessed with arch index, MDLS were measured by GEAMASTER stabilometer. There was significant positive correlation between foot posture and limits of stability. Diplegic children having pes-planus have better MDLS as compared with pes-cavus.
GowdaVKKumarAShivappaSK, et al. Clinical profile, predisposing factors, and associated co-morbidities of children with cerebral palsy in South India. J Pediatr Neurosci. 2015;10(2):108-113. doi:10.4103/1817-1745.159191.
2.
RanaMUpadhyayJRanaAJDurgapalSJantwalA.A systematic review on etiology, epidemiology, and treatment of cerebral palsy. Int J Nutr Pharmacol Neurol Dis. 2017:76-83. doi:10.4103/ijnpnd.ijnpnd_26_17.
3.
ChauhanASinghMJaiswalNAgarwalASahuJKSinghM.Prevalence of cerebral palsy in Indian children: a systematic review and meta-analysis. Indian J Pediatr. 2019;86(12):1124-1130. doi:10.1007/s12098-019-03024-0.
4.
BourelleSBergeBGautheronVCottalordaJ.Computerized static posturographic assessment after treatment of equinus deformity in children with cerebral palsy. J Pediatr Orthop B. 2010;19(3):211-220. doi:10.1097/BPB.0b013e32832e957a.
5.
KulkarniPRThosarJA.Effect of arch index of foot on dynamic balance in healthy young adults. Indian J Physiother Occup Ther. 2020;14:134-140. doi:10.37506/ijpot.v14i4.11315.
6.
CoteKPBrunetMEGansnederBMShultzSJ.Effects of pronated and supinated foot postures on static and dynamic postural stability. J Athl Train. 2005;40(1):41-46.
7.
PickerillMLHarterRA.Validity and reliability of limits-of-stability testing: a comparison of 2 postural stability evaluation devices. J Athl Train. 2011;46(6):600-606. doi:10.4085/1062-6050-46.6.600.
8.
LendeSVijaymunirajJSM. Concurrent validity of pediatric balance scale with computerized posturography. Int J Curr Res Rev. 2011;3:206-213.
9.
User Manual Gea Master vers. 1.3. Published October 2020. www.vertigomed.it
10.
GalliMCimolinVPauMLebanBBrunnerRAlbertiniG.Foot pressure distribution in children with cerebral palsy while standing. Res Dev Disabil. 2015;41-42:52-57. doi:10.1016/j.ridd.2015.05.006.
11.
SilvaDBPfeiferLIFunayamaCA.Gross motor function classification system expanded & revised (GMFCS E & R): reliability between therapists and parents in Brazil. Braz J Phys Ther. 2013;17(5):458-463. doi:10.1590/S1413-35552012005000113.
12.
RoyHRayKDebSBhattacharyaK.Arch index: an easier approach for arch height (a regression analysis). Al Ameen J Med Sci. 2012;5(2):137–146.
13.
CavanaghPRRodgersMM.The arch index: a useful measure from footprints. J Biomech. 1987;20(5):547-551. doi:10.1016/0021-9290(87)90255-7.
14.
SaxenaSRaoBKKumaranS.Analysis of postural stability in children with cerebral palsy and children with typical development: an observational study. Pediatr Phys Ther. 2014;26(3):325-330. doi:10.1097/PEP.0000000000000060.
15.
SeesJPMillerF.Overview of foot deformity management in children with cerebral palsy. J Child Orthop. 2013;7(5):373-377. doi:10.1007/s11832-013-0509-4.
16.
RukmangathanKJeyarajD.Influence of flatfoot on ankle range of motion and dynamic balance among college students. Int J Res Sci Innov. 2019; VI(XI):78-81.
17.
MeghaSMadhuriJManjiriK.Effect of flat feet on static and dynamic balance in adults. Indian J Physiother Occup Ther. 2022;16(1):76-85.
18.
Puszczalowska-LizisEBujasPOmorczykJJandzisSZakM.Feet deformities are correlated with impaired balance and postural stability in seniors over 75. PLoS ONE. 2017;12(9). doi:10.1371/journal.pone.0183227.
19.
SharmaKSamuelAJMidhaDAranhaVPNarkeeshKArumugamN.Multi-directional reach test in South Asian children: normative reference scores from 5 year to 12 years old. Homo. 2018;69(1-2):62-69. doi:10.1016/j.jchb.2018.03.008.
20.
MarouvoJCastroMASantosCSousaF.Correlation between different methods to diagnose foot posture condition. J. 2021;4:233-243. doi:10.3390/j4030019.
21.
ZarkouALeeSCKProsserLAJekaJJ.Foot and ankle somatosensory deficits affect balance and motor function in children with cerebral palsy. Front Hum Neurosci. 2020;14:45. doi:10.3389/fnhum.2020.00045.
22.
MeyerPFOddssonLIDe LucaCJ.The role of plantar cutaneous sensation in unperturbed stance. Exp Brain Res. 2004;156(4):505-512. doi:10.1007/s00221-003-1804-y.
23.
Ferber-ViartCIonescuEMorletTFroehlichPDubreuilC.Balance in healthy individuals assessed with equitest: maturation and normative data for children and young adults. Int J Pediatr Otorhinolaryngol. 2007;71(7):1041-1046.
24.
DaleidenS.Weight shifting as a treatment for balance deficits: a literature review. Physiother Can. 1990;42:81-87.
25.
TedlaJSSangadalaDRGularK, et al. Normative reference values for functional, lateral, and oblique direction reach tests in Saudi children aged six to 15 years old and psychometric properties of the oblique direction reach test. Niger J Clin Pract. 2021;24(4):576-583. doi:10.4103/njcp.njcp_102_20.
26.
HsueBJMillerFSuFC.The dynamic balance of the children with cerebral palsy and typical developing during gait. Part I: spatial relationship between COM and COP trajectories. Gait Posture. 2009;29(3):465-470. doi:10.1016/j.gaitpost.2008.11.007.
27.
RighiNMartinsFSouzaJTrevisanC.Plantar pressure distribution and foot morphology of children with cerebral palsy and typical development. Fisioter Pesqui. 2017;24:321-326. doi:10.1590/1809-2950/17454624032017.
28.
KusumotoYTsuchiyaJWatanabeY, et al. Characteristics of dynamic standing balance with and without an insole in patients with spastic diplegia cerebral palsy. J Phys Ther Sci. 2020;32(1):23-26. doi:10.1589/jpts.32.23.
29.
AbdElAzizHGKhatibAHEHamadaHA.Does the type of toeing affect balance in children with diplegic cerebral palsy? An observational cross-sectional study. J Chiropr Med. 2019;18(3):229-235. doi:10.1016/j.jcm.2019.01.005.
