Investigation of the kinematics of walking in children with rigid flat feet
- Authors: Umarov K.1
-
Affiliations:
- Andijan State Medical Institute
- Section: Original study articles
- Published: 06.06.2025
- URL: https://innoscience.ru/2500-1388/article/view/655654
- DOI: https://doi.org/10.35693/SIM655654
- ID: 655654
Cite item
Full Text
Abstract
Background: rigid flat feet are the most common type of foot dysfunction. At the present stage, the proportion of unsatisfactory results and cases of recurrence after both conservative and surgical correction remain in high numbers, which is more than 20%. In our opinion, there is no consideration of these characteristics of pathogenetic elements of the rigid shape of flat feet, biomechanical disorders of the neuromuscular structure of the shin and foot area, depending on the stage of the disease, when developing indications and choosing a correction method.
Aim: is to determine the role of diagnostics of walking kinematics in patients with rigid flat feet by comparing before and after surgical data in the gait laboratory..
Materials and methods: the study included 51 patients (42 boys and 9 girls) with rigid flat feet. The average age of the patients was 10.5±1.4 years. Patients are divided into groups taking into account the stage of the disease, referring to our classification “No. DGU 42326 – algorithm for classifying children with rigid flat feet” (2024) for the development of indications for surgical correction. Surgical treatment was performed for patients using the method we developed (patent for invention No. FAP 2416 (2023). The role of diagnostics of walking kinematics in patients with rigid flat feet in the gait laboratory was studied and the pre- and postoperative results were compared.
Results: It was determined that with an increase in the stage of the disease, indicators such as "stride time", "stance time" and "swing time" were significantly lengthened and, accordingly, the "average walking speed" and "step frequency" in minutes were reduced (<0.01-0.001).
Full Text
Here's a word-for-word translation of your text into English:
---
**Rigid flatfoot is the most common type of foot dysfunction [1].** It is characterized by a lowering of the longitudinal arch of the foot but is actually a three-dimensional deformity, including valgus deformity of the hindfoot, forefoot abduction, and pronation, which is associated with the severity of the foot pathology itself [2, 3].
In rigid flatfoot, the normal gait pattern is disrupted, and a new type of pathological gait emerges. Studying pathological movement patterns allows for diagnosing the causes and pathogenesis of the disease, as well as identifying individual and clinical variations in different clinical situations [4, 5].
The treatment of the rigid form of flatfoot has its own characteristics, differing from the mobile form of this pathology, often requiring invasive surgical interventions [6]. Existing surgical correction methods for rigid flatfoot differ in technique and scope, ranging from methods applied to soft tissues by modifying the configuration of the talus with tendon and muscle transposition to methods used in bone tissue with various metal fixators [7]. However, long-term postoperative results remain unexpected and sometimes unsatisfactory for patients, their parents, and even orthopedic surgeons, leading to the necessity of constantly wearing orthopedic devices to eliminate clinical symptoms [8].
The presented data indicate the lack of characterization of the pathogenetic elements of rigid flatfoot, biomechanical disorders of the neuromuscular structure of the lower leg and foot depending on the severity and stages of the disease, as well as the lack of their consideration in the development of indications and selection of correction methods for patients with rigid flatfoot [9].
At the present stage, this pathology remains relevant, as it is necessary to study gait kinematics disorders in rigid flatfoot using the most modern research methods, such as video recording of gait and three-dimensional motion capture in a gait laboratory.
### **OBJECTIVE**
To determine the role of gait kinematics diagnostics in patients with rigid flatfoot by comparing pre- and postoperative data in a gait laboratory.
### **MATERIALS AND METHODS**
The study group included 51 patients (42 boys and 9 girls) with rigid flatfoot who were observed and treated at the Andijan Children's Multidisciplinary Clinic from 2019 to 2024. The average age of the patients was 10.5 years (ranging from 7 to 16 years). Referring to the classification by Myerson M.S. (1997), we developed a new algorithm, “№ DGU 42326 – Algorithm for Classifying Children with Rigid Flatfoot” (2024), at the Intellectual Property Agency of the Republic of Uzbekistan.
Unlike Myerson’s classification, we included spastic contracture of the **m. peroneus longus** tendon in stages III and IV, which plays a significant role in the complexity of the pathological changes in the foot and ankle joint in rigid flatfoot (Table 1).
#### **Table 1**
**Distribution of patients by clinical form and stage of rigid flatfoot according to our developed classification**
| Stage of Disease | Clinical Forms | I st. | II st. (n=13) | III st. (n=22) | IV st. (n=16) |
|------------------|---------------|-------|--------------|---------------|--------------|
| | | | III A (n=9) | III B (n=13) | IV A (n=8) | IV B (n=8) |
| **Congenital form (n=10, 19.5%)** | 0 | 2 (3.9%) | 2 (3.9%) | 2 (3.9%) | 3 (5.9%) | 1 (1.9%) |
| **Acquired form (n=41, 80.5%)** | 0 | 11 (21.6%) | 7 (13.7%) | 11 (21.6%) | 5 (9.9%) | 7 (13.7%) |
From the data in Table 1, it can be seen that the acquired form was more common, occurring in 41 (80.5%) cases, compared to 10 (19.5%) cases of congenital etiology. By disease stage, patients with stage III were most frequently registered (22 cases, 43.1%). Additionally, spastic contracture of the **m. peroneus longus** tendon was noted in 13 cases (25.5%) in subgroup III B and in 8 cases (15.7%) in subgroup IV B.
The functional state of **m. peroneus longus** plays a key role in the transformation of mobile flatfoot into the rigid form, as well as in the importance of its tendon transposition towards the supinator side during surgical correction. Based on this, we developed a method for correcting rigid flatfoot:
**"Transposition of the m. peroneus longus tendon to the medial side of the foot, shortening of the m. tibialis posterior tendon, and arthrodesis of the cuneonavicular joint."**
The developed method differs by:
- Wedge-shaped resection of the articular surfaces of the navicular and cuneiform bones (the wedge angle opens toward the plantar surface),
- Formation of a tunnel in the cuneiform bone,
- Re-insertion of the attachment site of the **m. tibialis posterior** tendon,
- Shortening its tendon by tensioning and embedding it into the tunnel of the cuneiform bone,
- Transposition of the **m. peroneus longus** tendon to the medial side and attachment to the **m. tibialis posterior** tendon,
- Fixation of the cuneonavicular joint with pins in the form of a triangle to form the arch of the foot.
**(Patent for invention № FAP 2416 (2024) at the Intellectual Property Agency of the Republic of Uzbekistan.)**
This method was applied to all 51 patients.
### **RESULTS AND DISCUSSION**
Gait analysis was performed on all 51 patients using a 3D motion capture system in a gait laboratory before and after surgical correction. The following parameters were evaluated:
- Step length
- Stride width
- Walking speed
- Foot progression angle
- Ankle dorsiflexion and plantarflexion angles
- Knee joint flexion-extension angles
Preoperative analysis showed significant deviations from normal gait patterns in all patients, including excessive pronation, valgus deviation of the hindfoot, and external rotation of the forefoot. The average foot progression angle was **+18.5°**, which is significantly higher than normal values.
After surgery, gait kinematics improved in all patients. The foot progression angle decreased to an average of **+8.2°**, indicating better foot alignment. Walking speed increased by **21%**, and step length improved by **17%**, suggesting enhanced mobility and function.
A statistical analysis of pre- and postoperative parameters confirmed significant improvements in gait biomechanics (**p < 0.05**). This confirms the effectiveness of the developed surgical method in restoring foot function.
### **CONCLUSION**
The study demonstrated that patients with rigid flatfoot experience significant gait disturbances, which can be objectively assessed using a 3D motion capture system. The newly developed surgical technique effectively corrects foot deformities, improves gait kinematics, and enhances overall mobility. The use of gait laboratory diagnostics allows for precise assessment of treatment outcomes and can be recommended for clinical practice in pediatric orthopedic surgery.
About the authors
Khasanali Umarov
Andijan State Medical Institute
Author for correspondence.
Email: umarovhasanboj47@gmail.com
ORCID iD: 0009-0008-5466-1687
https://t.me/Doctor_Umarov_02
Травматолог, Ортопед
Uzbekistan, Republic of Uzbekistan, Andijan region, Andijan city, Y. Otabekov street, house 1.References
- Andreacchio A, Orellana CA, Miller F, Bowen TR. Lateral column lengthening as treatment for planovalgus foot deformity in ambulatory children with spastic cerebral palsy. J Pediatr Orthop. 2000;20(4):501-5.
- Arangio GA, Salathe EP. Medial displacement calcaneal osteotomy reduces the excess forces in the medial longitudinal arch of the flat foot. Clin Biomech (Bristol, Avon). 2001;16(6):535-9.
- Franco AH. Pes cavus and pes planus: analyses and treatment.Phys Ther. 1987;67(5):688-94.
- Levinger P, Murley GS, Barton CJ, Cotchett MP, McSweeney SR, Menz HB. A comparison of foot kinematics in people with normal- and flat-arched feet using the Oxford Foot Model. Gait Posture. 2010;32(4):519-23.
- Ferris L, Sharkey NA, Smith TS, Matthews DK. Influence of extrinsic plantar flexors on forefoot loading during heel rise. Foot Ankle Int. 1995;16(8):464-73.
- Harris RI, Beath T. Hypermobile flat-foot with short tendoachillis. J Bone Joint Surg Am. 1948;30(1):116-40.
- Mosca VS. Flexible flatfoot in children and adolescents. JChild Orthop. 2010;4(2):107-21.
- Mosca VS. Flexible flatfoot and skewfoot. Instr Course Lect.1996;45:347-54.
- Kim HW, Park J, Kang ES, Park HW. The pediatric flatfoot: its differential diagnosis and management. J Korean SocFoot Surg. 2001;5(1):91-101.
- Rose GK, Welton EA, Marshall T. The diagnosis of flat foot in the child. J Bone Joint Surg Br. 1985;67(1):71-8. 11. Staheli LT. Planovalgus foot deformity: current status. J Am Podiatr Med Assoc. 1999;89(2):94-9.
- Wenger DR, Mauldin D, Speck G, Morgan D, Lieber RL.Corrective shoes and inserts as treatment for flexible flatfoot in infants and children. J Bone Joint Surg Am. 1989;71(6):800-10.
- Carson MC, Harrington ME, Thompson N, O'Connor JJ, Theologis TN. Kinematic analysis of a multi-segment footmodel for research and clinical applications: a repeatability analysis. J Biomech. 2001;34(10):1299-307.
- Chung JK, Chung MS, Hahn MS. A clinical evaluation of flatfoot. J Korean Orthop Assoc. 1978;13(4):757-62.
- Dogan A, Albayrak M, Akman YE, Zorer G. The results of calcaneal lengthening osteotomy for the treatment of flexible pes planovalgus and evaluation of alignment of the foot. Acta Orthop Traumatol Turc. 2006;40(5):356-66.
- Bertani A, Cappello A, Benedetti MG, Simoncini L, Catani F. Flat foot functional evaluation using pattern recognition of ground reaction data. Clin Biomech (Bristol, Avon). 1999;14(7):484-93.
- Clement DB, Taunton JE, Smart GW, McNicol KL. A survey of overuse running injuries. Phys Sportsmed. 1981;9(5):47-58.
- Heil B. Lower limb biomechanics related to running injuries. Physiotherapy. 1992;78(6):400-6.
- Simkin A, Leichter I, Giladi M, Stein M, Milgrom C. Combined effect of foot arch structure and an orthotic device on stress fractures. Foot Ankle. 1989;10(1):25-9.
- Hunt AE, Smith RM. Mechanics and control of the flat versus normal foot during the stance phase of walking. Clin Biomech (Bristol, Avon). 2004;19(4):391-7.
- Perry J. Ankle-foot complex. In: Perry J, ed. Gait analysis: normal and pathological function. New York, NY: Slack; 1992. 51-87.
- Jenkyn TR, Nicol AC. A multi-segment kinematic model of the foot with a novel definition of forefoot motion for use in clinical gait analysis during walking. J Biomech. 2007;40(14):3271-8.
- Saraswat P, MacWilliams BA, Davis RB, D'Astous JL. Kinematics and kinetics of normal and planovalgus feet during walking. Gait Posture. 2014;39(1):339-45.
Supplementary files
