Patients with arthrogryposis may experience functional limitations

HOUSTON — Patients with arthrogryposis may experience foot deformities, gait deviations and functional limitations in gross motor function and in gait in ankle force power generation, according to a presenter at the Association of Children’s Prosthetic-Orthotic Clinics Annual Meeting, here.

“The aim of our research was to quantify gait deviations and foot deformities in patients with arthrogryposis using detailed gait analysis, including multi-segment foot kinematics and foot pressure analysis,” L. Reid Nichols, MD, of the Nemours I. duPont Hospital for Children, Gait Laboratory, said.

Nichols and colleagues conducted a retrospective study of 42 patients with arthrogryposis, aged 2 years to 20 years and compared data to that of typically developing patients. Comprehensive evaluation data included full gait analysis with multi- and single-segment foot kinematics, kinetics and pedobarographs. Physical examinations and radiographic measurements were reported, and in addition to evaluating the sample as a whole, the patients were grouped by age, orthotic use and history of surgical intervention.

The physical exam and kinematic data showed that children with arthrogryposis walked with a crouched gait, demonstrated stiffness in the hips, knees and ankles and showed limitations in their gross motor functioning. Nichols said power generation was low at the ankle and high at the hip, and that multi-segment foot kinematics revealed stiffness in hindfoot plantarflexion and residual forefoot adduction. In addition, foot posture showed reduced heel impulse, excessive midfoot contact and overall varus foot position.

“Categorization by age revealed greater stiffness at the hips and knees in older children,” Nichols said. “Children with [knee-ankle-foot orthosis] KAFOs showed the most stiffness compared to those with [ankle-foot orthoses] AFOs or no orthoses.”

Nichols added that no significant differences were seen between the foot posture of children with clubfoot treated operatively or by the Ponseti method, except for greater internal rotation at the foot in Ponseti-treated feet.

“Overall, children with arthrogryposis, walk with a crouched, stiff gait and have foot deformities,” Nichols said. “In addition, residual varus of the foot, as well as forefoot adduction, suggests persistence of clubfoot deformities. – by Shawn M. Carter


Nichols LR, et al. Foot deformities and gait deviations in children with arthrogryposis. Presented at: Association of Children’s Prosthetic-Orthotic Clinics Annual Meeting; March 22-25, 2017; Houston.

Disclosure: Nichols reports no relevant financial disclosures.


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