Combined three-dimensional gait and plantar pressure analyses detecting significant functional deficits in children with juvenile idiopathic arthritis

Publication date: Available online 9 September 2018

Source: Gait & Posture

Author(s): Josephine Merker, Matthias Hartmann, Johannes-Peter Haas, Ansgar Schwirtz

Abstract

Background

Children suffering from juvenile idiopathic arthritis (JIA), a heterogeneous group of chronic inflammatory joint diseases, adapt to individual gait patterns to avoid loading of inflamed, swollen and painful joints. As the interpretability of previous studies is limited, this study aims to assess the functional capacity, loads and plantar pressure distribution in the gait of a homogeneous JIA group.

Research question

Does a symmetrical lower limb joint involvement influence the gait dynamics in JIA patients, and how are the results of three-dimensional gait analysis (3DGA) and pedobarography related?

Methods

Fifty JIA patients with symmetrical hip, knee and ankle joint arthritis and 27 healthy controls performed 3DGA and pedobarography at self-selected walking speeds. Kinematics and kinetics of lower limb joints were retrospectively compared in range of motion and in time-normalized waveforms. Plantar load was evaluated by measuring peak pressure, pressure-time integral and maximum force of the whole foot and ten selected foot regions. 1D-SPM analysis, parametric and non-parametric statistical significance tests and correlation coefficients were used for statistical analysis.

Results

JIA patients had a significantly slower walking speed with an anteriorly tilted pelvis and a reduced extension motion of all joints of the lower limb. The horizontal ground reaction forces and generated hip and ankle power during propulsion phase were small. Patients experienced reduced loading at toe regions, which correlated with limited ankle plantarflexion motion in the push-off phase. The total peak pressure was significantly increased and loads at lateral midfoot and metatarsal regions were higher in patients.

Significance

Symmetrical lower limb arthritis is linked to crouch-like gait and restricted gait dynamics with increased total peak pressure. The results confirm earlier results of 3DGA and provide new insights regarding waveform analysis and plantar loading in JIA patients. The used methods help to design individualized functional treatment of JIA patients.

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