Clinical Efficacy of Shoes and Custom-modeled Insoles in Treating Down Syndrome Children with Flatfoot

Research Article

Phys Med Rehabil Int. 2015; 2(8): 1061.

Clinical Efficacy of Shoes and Custom-modeled Insoles in Treating Down Syndrome Children with Flatfoot

Keiji Hashimoto*, Sayaka Aoki, Kohei Miyamura, Anri Kamide and Manami Honda

Division of Rehabilitation Medicine and Developmental Evaluation Center, National Center for Child Health and Development, Tokyo, Japan

*Corresponding author: Keiji Hashimoto, Division of Rehabilitation Medicine and Developmental Evaluation Center, National Center for Child Health and Development Okura Setagaya-ku Tokyo, Japan

Received: September 14, 2015; Accepted: October 07, 2015; Published: October 10, 2015

Abstract

Objective: In this study, we performed a prospective study to determine whether wearing shoes and custom-modeled insoles can influence the walking pattern of Down syndrome (DS) children with flatfoot.

Methods: Participants consisted of 41 DS children with flatfeet that were prescribed orthotic insoles. A 2.4 m sheet-type gait analyzer was used to analyze gait patterns. We measured the following variables: walking velocity (cm/min), cadence (steps/min), step length (cm), and single-limb stance (SLS) phase ratio (%) in three conditions. In the first condition, the participants walked barefoot, in the second, they wore shoes without insoles, and in the third condition, and they wore shoes with custom-modeled insoles.

Results: When compared with the barefoot condition, significant increases in walking speed, step length, and SLS phase ratiowere observed in the group wearing shoes with custom-modeled insoles (repeated measure ANOVA; p=0.010, 0.000, 0.000).

Conclusion: Our results indicate the clinical efficacy of shoes and custommodeled insoles in increasing walking velocity, step length and SLS phase ratio of DS children, which are determinants of gait maturity.

Keywords: Down syndrome; Flatfoot; Gait analysis; Custom-modeled insoles

Introduction

Down syndrome (DS) results from a common chromosome abnormality in live births (1 in 800-1000) [1] and shows a variety of dysmorphic features, congenital malformations, and other health problems and medical conditions. Frequently, children with DS suffer from musculoskeletal problems, including hypotonia, ligament laxity, atlantoaxial instability, hip and patella dislocation, foot deformities, and the delayed achievement of motor milestones [2-4]. Specifically, flatfoot is a prevalent musculoskeletal problem observed among DS children, with an estimated prevalence range of 19.9% to 83% [2,5]. At the National Center for Child Health and Development, Tokyo, we routinely monitor the gait pattern in DS children and in other children with gait impairment using the sheet-type limb gait analyzer. Sutherland et al., investigated determinants of gait maturity in typical children, and described 5 aspects of gait changes over time: increases in walking velocity, step length, duration of singlelimb stance (SLS), and the ratio of pelvic span to ankle speed, and a decrease in cadence [6]. Young D Schildren show delayed acquisition of the ability to control their legs smoothly, possibly due to hypotonus [7], thus, unique patterns of development for each gait parameter are expected. Several therapies have been developed to address these developmental issues, including the use of customized orthoses [8]. However, the clinical efficacy of customized insoles as therapy for gait abnormalities in DS children has not been examined. Here, we performed a prospective analysis of the gait of young DS children who are prescribed insoles for flat feet, to identify the clinical efficacy of shoes and custom-modeled insoles as therapy for gait abnormalities in DS children.

Methods

Participants

Forty-one DS pediatric patients (20 boys; age range, 1-13 years; mean age, 4.2 ± 2.5 years) diagnosed with flatfeet and prescribed with orthotic insoles at our institution, the National Center for Child Health and Development, between July 2010 and October 2013 were included in the study. All the participants had achieved independent walking before proceeding to our gait evaluation. Experienced physiatrists made the diagnosis of flatfeet. The criteria for insoles prescription were as follows; (i) existence of flatfeet, (ii) their walking pattern are stabilized by wearing insoles, (iii) their family want to use custom-modeled insoles to improve walking pattern of the patients. Prior to participation in the study, the subjects’ parents provided informed consent. This study was approved by the research ethics committee of the National Center for Child Health and Development.

Equipment, procedures, and measures

Gait pattern was analyzed using a 2.4 m sheet-type gait analyzer, Walk Way MW-1000™ (Anima, Tokyo, Japan). The equipment allows the users to analyze the gait pattern of an individual walking on the long thin sensor sheet through real-time monitoring of the individual’s foot contact and foot pressure distribution. Data includes diverse variables relevant to gait pattern. For this study, the following variables were calculated from collected data: (i) walking velocity (cm/min); (ii) cadence (steps/min); (iii) step length (cm; Figure 1); and (iv) SLS phase ratio (%, ratio of the time during which only one foot was in contact with the ground to that of the whole stride. Data for the first three variables was produced directly by the gait analyzer. For the last variable, the SLS phase ratio was calculated using three variables measured by the gait analyzer: duration of stance phase (length of time for which a foot is in contact with the ground); duration of double-limb stance (DLS) phase (length of time for which both feet are in contact with the ground); and duration of swing phase (length of time for which a foot is not in contact with the ground), using the following formula:

Citation: Hashimoto K, Aoki S, Miyamura K, Kamide A and Honda M. Clinical Efficacy of Shoes and Custommodeled Insoles in Treating Down Syndrome Children with Flatfoot. Phys Med Rehabil Int. 2015; 2(8): 1061. ISSN:2471-0377