Description clinique et radiologique des malformations des pieds et des membres inférieurs chez les patients atteints du syndrome de Down

Abstract

Subjects with Down syndrome (DS) are known to be affected by various lower limb deformities [1], [2]. Foot deformities are often neglected in DS patients because of the high prevalence of concomitant life threatening disorders. The aim of this study is to investigate the prevalence of clinical and radiological feet and lower limb deformities in patients with DS. Fifty-five subjects with DS (14.6 A7.4 years) had undergone podiatric clinical and podoscopic examinations to study their main foot deformities and their footprints, respectively. The results of these examinations were compared to those of an age-matched asymptomatic control group of 53 subjects (13.4 A11.2 years). Forty-two subjects of the DS group (15 A7 years) had undergone an EOSy biplanar X-rays exam of their pelvis and lower limbs. The EOS parameters were compared to an asymptomatic control group of 27 subjects (16.12 A6 years). The following foot deformities were found to be significantly more prevalent in DS group - hallux valgus (36.4%), syndactyly between 2nd–3rd toes (9.1%), grade II pes planus (39.1%) and grade III pes planus (30%). Moreover, an increased space between the 1st and 2nd toes in patients with DS with a prevalence of 73.6% was found. Patellar instability (42.7%) and joint laxity (43.6%) were also significantly more prevalent in the DS group. The following EOS parameters were significantly higher in DS group compared to control group - pelvic incidence (53°A13° vs. 44°A10°, P < 0.001), sacral slope (48°A9° vs. 37°A6°, P < 0.001) and femoral neck-shaft angle (133°A6° vs. 131°A5°, P = 0.021). On the other hand, other EOS parameters were significantly higher in the control group - femoral head diameter (mean = 41 vs. 38) and femoral offset (mean = 37.64 vs. 34). There were no significant differences between the DS and the control groups for both femoral anteversion and tibial torsion. This study confirms the previously reported high prevalence of foot deformities in patients with DS [2]. Furthermore, increased space between the first and second toes was described for the first time in Down syndrome patients. Considering its high prevalence, further studies should be directed towards exploring the functional implications of this deformity. To our knowledge, this is the first study to measure lower limb and pelvic radiological parameters of patients with DS. The morphology of both the pelvis and the proximal femur were affected in patients with DS. Further studies should explore the effect of these anomalies on gait and posture in this group of patients.