Foot deformities and gait deviations in children with arthrogryposis

Objectives: Arthrogryposis multiplex congenita is a congenital condition characterized by joint contractures with resulting foot deformities and gait deviations. The aim of this study was to describe gait deviations and foot deformities in children with arthrogryposis objectively and quantitatively with detailed gait analysis, including multisegment foot kinematics and foot pressure analysis. Materials and Methods: Children with arthrogryposis were evaluated retrospectively. Their data were compared to data from typically developing children. Comprehensive data presented include results of a full gait analysis with multisegment or single-segment foot kinematics, kinetics, pedobarograph, physical examination, and radiographic measurements. Children were grouped by age, orthotic use, and history of surgical intervention. Results: Forty-two children with arthrogryposis (2-20 years old) were reviewed. Physical examination and kinematic data showed that children walked with a crouched gait; exhibited stiffness in the hips, knees, and ankles; and showed limitations in their gross motor functioning. Power generation was low at the ankle and was high at the hip. Multisegment foot kinematics revealed stiffness in hindfoot plantar flexion and residual forefoot adduction. Foot pressure 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. Children with knee-ankle-foot orthosis showed the most stiffness. Conclusions: Three-dimensional motion analysis and plantar pressure measurements are able to quantify the empirical observations of children with arthrogryposis walking with a crouched, stiff gait and having foot deformities. The use of these technologies in conjunction with clinical examination and functional tests is, therefore, recommended to monitor treatment efficacy and natural progression of gait deviations and joint deformities in arthrogryposis.