Recent study results offered preliminary evidence of changes in spatiotemporal gait parameters and confirmed flat foot posture and hypermobility of the lower limb following orthotic intervention in children with developmental coordination disorder.

“Our clinical experience has indicated that children with developmental coordination disorder (DCD) experience foot and gait problems,” Stewart C. Morrison, PhD, senior lecturer at the University of East London, told O&P Business News. “A few studies have been published describing gait characteristics in DCD but we are only aware of one study that had identified concerns with flat feet.”

Foot posture, hypermobility

Fourteen children with DCD were randomly assigned to an intervention group who received foot orthoses at the start of their rehabilitation program or to a second group who received foot orthoses at the end of their intervention program. Researchers assessed foot posture with the Foot Posture Index and lower limb hypermobility with the Lower Limb Assessment Score. At baseline and post-rehabilitation, researchers evaluated the effect of foot orthoses through assessment of spatiotemporal gait characteristics.

Stewart C. Morrison

Researchers observed a flat foot posture and lower limb hypermobility. At baseline the researchers found no significant differences between gait characteristics for the two groups, and no significant differences for cadence, double support duration or stride length at 7-week follow-up. However, patients demonstrated a trend toward a decreased cadence and increased double support duration. Although patients in both groups increased distance traversed in a 6-minute walk test at follow-up, results from the test did not differ significantly between the groups at baseline or follow-up.

“The overall trend of the results did tend to support our clinical impression on the effect of orthoses,” Morrison said. “We were hoping to find significant differences in the data, but given the small sample size we were not surprised we didn’t find this.”

The researchers also sought feedback from the children’s parents on the overall effects of the orthoses.

“We asked all parents to give subjective feedback on how beneficial they had found the orthoses and many reported they thought them beneficial and would continue their use, which was surprising in light of the lack of experimental evidence,” Morrison said. “Parents report less trips and falls, improved walking patterns and a positive response from the children. This would suggest that a patient reported outcome would be something to consider in future studies.”

Future research

Although the sample size recruited in this study was small, limiting the external validity of the work, the researchers said the results illuminate the need for consideration of the foot, lower limb and gait during clinical assessment of children with DCD. They recommended that future studies include patient outcome measures to establish the usefulness of orthoses in this group. However, according to the researchers, the trend offers preliminary support for podiatric intervention in children with DCD.

“This was a small study and a further clinical trial would be useful to provide robust evidence to advance clinical care for children with DCD,” Morrison said. “Further work is also required to understand the mechanics of foot function during gait in children with DCD, and the response to orthotic therapy.” — by Casey Murphy

For more information:

Morrison SC. Res Dev Disabil. 2013;34:3197-3201.
Disclosure: The researchers were supported by a financial contribution from Canonbury Healthcare.

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