Pattern Of Foot And Ankle Deformities In Children With Spastic Cerebral Palsy As Seen At A Kenyan Hospital

Abstract

Background: Cerebral palsy (CP) is a leading cause of childhood disability. Life expectancy in children and youth with cerebral palsy is directly influenced by the patients’ ability to ambulate and perform activities of daily living. As a result of muscle spasticity and contracture formation, approximately 20-50% of children with cerebral palsy develop lower limb deformities that affect ambulation. Objective: To determine the pattern of foot and ankle deformities in children with spastic cerebral palsy. Study design: A six month prospective observational study, conducted at the AIC CURE International Children’s Hospital outpatient clinic. Materials and methods: 176 patients, selected through a non-random convenience sampling, were recruited. Ethical approval was obtained from the KNH/UoN-ERC as well as the AIC CURE International Children’s Hospital – Kijabe Ethics and Research Committee. Patients were categorized by type of cerebral palsy and the GMFCS, foot deformity present and their ambulatory status. Combinations of the parametric and non parametric tests, t-test, chi-square test and Kruskal-Wallis tests were used for analysis. Data is presented in tables and figures. xii | P a g e Results One hundred and seventy six patients, 98(56%) male and 78(44%) females were recruited. Patients were aged between 2 and 15 years with a mean age of 7 years. Commonest type of spastic cerebral palsy was quadriplegia 83(47%), followed by diplegic 40(23%), hemiplegic 39(22%), triplegic 11 (6%) and mixed 3(2%). Spasticity was reported in all the patients. The most common type of foot and ankle deformity reported was equinus 68(38%), followed by pes planovalgus 54(31%), other types of deformities 49(28%) [Neurogenic talipes equinovarus (20%), pes planus (43%), cavovarus (2%), pes planovarus (4%) and calcaneovalgus (20%)], and hallux valgus 5(3%). Plantigrade feet were 96(55%) and tip toe walkers were 73(41%) and heel gait 7(4%). Callosity was found in 59(34%) all children. Most feet were in valgus with foot bisector line passing between 1st / 2nd toe webspace and 1st toe 87(49%), normal foot bisection with the bisector line passing through the 2nd and 3rd toe web spaces was found in 58 patients at 33%, varus feet were 30(17%) with foot bisector line passing between 3rd /4th toe web spaces and 4th toe. Mean thigh foot angle was 5.4 degrees and mean R1-R2 ratio was 6.3 degrees. Most patients had GMFCS V 50(28%), III with 44(25%), II 43(24%), IV 38(22%) and I with 1(0.6%). Most children were non ambulant 82(46%), community ambulators with walking aid were 47(27%) and fully mobile were 47(27%). Bilateral deformities were seen in 127(72%) of the children and unilateral deformities were reported in 49(28%). Mean range of motion of the ankle joint was 7.6 degrees for dorsiflexion and 28.9 degrees for plantarflexion xiii | P a g e Conclusion The foot and ankle deformities are common in children with spastic cerebral palsy; the pattern of the deformities is unpredictable probably because of muscle imbalance resulting from different types of brain injury and aetiology of the cerebral palsy