Influence of orthopedic shoes on the indicators of the interzonal load distribution on the foot when walking patients with cerebral palsy

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BACKGROUND: Clinical observations of patients with spastic forms of cerebral palsy and surveys showed the most commonly used technical rehabilitative device of this patient contingent are orthopedic shoes. However, almost no clinical and instrumental studies examine the effect of such shoes on the walking characteristics of patients with cerebral palsy (CP).
 AIM: This study aims to estimate the effect of orthopedic shoes on the interzonal load distribution on the plantar foot surface in children with CP and adolescents with different levels of gross motor function disorders (GMFCS).
 MATERIALS AND METHODS: Biomechanical studies were conducted in 42 patients with CP 5-16 years old with GMFCS 13 level while wearing standard and orthopedic shoes. In 14 healthy children controls while wearing standard shoes (a total of 112 feet). Biomechanical examinations were performed on the software and hardware complex DiaSled-M-Scan with matrix plantar pressure meters in the form of insoles. Statistical data analysis was performed using nonparametric methods via SPSS software for Windows.
 RESULTS: The use of complex orthopedic shoes in patients with level GMFCS 1 did not improve but worsened their foot loading parameters. The shoes reduced the loading of the heel, increased the toe-heel load ratio, and mediolateral load distribution in the fascicle area. In patients with GMFCS 2, the positive effect of orthopedic shoes was limited to improving the mediolateral load distribution in the fascicle area. In patients with GMFCS 3, the positive effect of orthopedic shoes was noted in the majority of the tested parameters.
 CONCLUSION: Thus, the study showed that in children and adolescents with CP using complex orthopedic shoes led to the most significant normalization of interzonal load distribution under the foot in GMFCS 3 patients, less significant in GMFCS 2 patients, and worsened the parameters in GMFCS 1 patients.