Posture In Children Research Articles

Assessment of Measurement Properties of Clinical Tests for Foot Posture in Children and Adolescents: A Systematic Review

ABSTRACT The study aimed to analyze, synthesize, and investigate the measurement properties of clinical tests that assess foot posture in children and adolescents. The study included research published in scientific journals that analyzed the measurement properties of clinical tests, focusing on the validity, reliability, responsiveness, or specificity of tests for assessing foot posture in children and adolescents (ages 4 to 18 years). Studies involving children with lower limb surgery, neurological issues, or deformities, reviews, case studies, and abstracts were excluded. The search followed PRISMA guidelines on MEDLINE, EMBASE, PUBMED, CINAHL, SPORTDIscus. The methodological quality was assessed using the COSMIN and Brink and Louw tool, while the certainty of the evidence was evaluated using GRADE. Twelve studies were included in this systematic review, evaluating the following clinical tests: foot posture index-6, normalized truncated navicular height, Staheli index, plantar arch index, arch height index, navicular drop, resting and neutral calcaneal stance position, pediatric flat foot proforma, subjective perception of the height of the feet arch and Clarke angle. Current clinical tests predominantly prioritize the examination of intra- and inter-rater reliability. Conversely, validity has only been found in restricted studies, and responsiveness has not been assessed. No evidence supports high-quality measurement properties for clinical tests evaluating foot posture in children and adolescents.

The effect of family posture control combined with GAME therapy on motor function in children with severe cerebral palsy.

This paper has a purpose to explore the effects of home posture control combined with goal-activity-exercise-environment therapy on motor function in children with severe cerebral palsy (CP). Data of 80 children with severe CP treated from January 2022 to December 2023 were collected. They were divided into experimental group (EG) and control group according to different treatment methods, with 40 people in each group. The controlled group (CG) obtained routine treating means, including occupational therapy, electromyographic biofeedback therapy, and other treatment items. The EG received a combination of home posture control and goal-activity-exercise-environment therapy on the basis of conventional treatment. Meanwhile, parents received professional training to manage their children's posture and received reinforcement training through goal-activity-exercise-environment therapy. The Gross motor function measure-88, Peabody developmental motor scale-fine motor, pediatric balance scale, Fugl-Meyer assessment and other scales were used to evaluate the motor function, balance ability, daily living activity ability, and developmental level of patients. After 3 months of treatment, the Gross motor function measure-88 scores of these 2 groups were 70.96 ± 18.29 and 57.42 ± 21.41, respectively. The Peabody developmental motor scale-fine motor scores were 76.48 ± 14.42 and 59.77 ± 14.89, respectively. The balance ability index, upper limb motor function index, daily living activity ability, and developmental level of the EG were significantly higher than the CG's, and the P-values were all <.05. The combination of home posture control and GAME therapy can significantly improve the motor function and daily living activities of children with severe CP. This helps to maintain the normal growth and development of the child, and has certain clinical value.

Penyuluhan Fisioterapi tentang Deteksi Dini dan Pencegahan Skoliosis pada Siswa di SDN Polowijen 1 Kota Malang

Child development is currently experiencing significant progress. However, children often experience posture problems such as scoliosis, lordosis, kyphosis, and shoulder asymmetry. If not treated immediately, this problem can continue into adulthood. To find out what is wrong with a child's posture, it is important to find it early. Posture correction is also important for children with posture problems. This counseling aims to teach how to diagnose scoliosis in oneself, prevent it in teenagers and increase awareness and knowledge about maintaining health and good body posture. Scoliosis education methods for children include health promotion, use of posters, pre-tests and post-tests, as well as education about scoliosis. This activity was attended by 27 participants aged 11 - 12 years at SDN Polowijen 1 Malang City. The consequences of this action show an increase in student information about scoliosis with a normal pre-test average of 62.8% to a post-test of 96.2%.

Socioeconomic disparities in children's posture defects: a comparison between private and public educational institutions

The topic of risk factors for posture pathology in Polish children is relevant at present, as it is insufficiently studied and reflects the need to investigate the relationship between family socioeconomic status and the occurrence of posture defects, to develop relevant prevention and treatment strategies in the context of current socioeconomic conditions in Poland. The research aims to study posture defects in children depending on their socioeconomic status in the example of private and public schools. A comparison of the prevalence of deformities and posture disorders of participants in private and public educational institutions from 2017 to 2020 is presented. Theoretical research methods (literature analysis, generalisation); empirical methods (study of other researchers' experience), statistical analysis, and graphical presentation of data were used. More than 1300 Polish schoolchildren from private and public schools took part in this cross-sectional study. The most common problems were flat feet (54.73%), calf muscle contracture (44.30%), and valgus deformity (21.22%). The least common problems were funnel chest (0.37%), cavus foot (0.10%), and hammer toe deformity (0.04%). The general trend shows that problems with flat feet and calf muscle contracture were more common among participants in both types of educational institutions. There was a general trend of increasing the number of nosological forms per patient in both private and public institutions over a period of three years. Private institutions had significantly fewer cases of one patient having more than one nosological form as compared to public institutions.

COMPLEX USE OF PHYSICAL THERAPY MEANS IN THE REHABILITATION OF SCHOOL-AGE CHILDREN WITH POSTURE DISORDERS

Relevance of the research topic. The problem of using physical therapy means in rehabilitation of school-age children with posture disorders becomes especially relevant in the context of the threat of serious spinal diseases, which can negatively affect the health and physical development of children in the future.Purpose and methods of the study. The aim of the work is to reveal the essence of complex use of physical therapy means in rehabilitation of school- age children with posture disorders. The research consisted of the analysis of scientists' works and description of the use of therapy for correction of school-age children's posture. Research methods and statistical analysis. We used both general scientific and special methods of research, namely: analysis, synthesis, structural-functional, description, generalization.Results. The article presents an analysis of the integrated use of physical therapy in the rehabilitation of school-age children with postural disorders. Various methods and techniques of physical therapy aimed at restoring optimal physical functioning and correcting postural defects are described. It is described that the main methods of physical therapy used in rehabilitation are therapeutic physical culture, correction of body position, therapeutic massage, hardening, hydrokinesitherapy and physiotherapy. Particular attention is paid to physical exercises that specialize in correcting specific types of posture disorders. Key findings. It has been shown that symmetrical and asymmetrical exercises, known as corrective exercises, are used to equalize the tone of the trunk muscles and strengthen relaxed muscles, helping to return the spine to its correct position. It has been proven that therapeutic massage, as an effective means of functional therapy, is used at all stages of medical and physical therapy to treat various diseases and injuries. The article analyzes the effectiveness of these methods and their role in achieving positive results in the rehabilitation of children with postural disorders.

Electrocardiographic and Autonomic Nervous System Changes after Changes in the Posture of Children and Adolescents with Duchenne Muscular Dystrophy.

Duchenne Muscular Dystrophy (DMD) is a rare inherited neuromuscular disease. At first, cardiac involvement may be asymptomatic. Therefore, assessing patients using non-invasive methods can help detect any changes. Analyze the electrocardiogram (ECG) test and heart rate variability (HRV) of the DMD group and compare the information with that of the age-matched control group. A prospective study with 27 male patients with DMD (11.9 years old), who underwent clinical evaluation, ECG, echocardiogram, and Holter monitoring. ECG (200% increase) was assessed by two independent observers. HRV was measured over time (24 h) and in the frequency domain, in the supine and sitting positions. The healthy group consisted of nine patients (11.0 years old). A value of p < 0.05 was considered statistically significant. The mean ejection fraction (EF) was 60% (34 to 71%). The Kappa coefficient for ECG measurements ranged from 0.64 to 1.00. An increase in the R/S ratio in V1 was observed in 25.9% of the subjects, pathological Q wave in 29.6%, and fragmented QRS in 22.2% in inferior/high lateral regions, with a negative correlation with EF (p = 0.006). There was low HRV, without the influence of any variable, including treatment. With the change in position, there was an increase in HR (p = 0.004), but there was no change in HRV. The LF/HF ratio was 2.7 in the DMD group and 0.7 in the control group (p = 0.002). In DMD subjects, prominent R waves in V1 and changes in the inferior/high lateral regions occurred in almost 30% of the cases. Lower vagal tone was observed without the influence of the variables age, ejection fraction, QT dispersion, and treatment. Despite the increase in HR, there was no adequate HRV response to the change in position.

Effects of Gluteal Muscle Focused Exercise Regimen on Functional Movement and Posture in Children with Down Syndrome: Pilot Study

Background: This article emphasizes the importance of the gluteal muscles in children with Down syndrome,revealing their impact on posture and functional movement.Purpose: The motive of this study was to assess the remedial effects of the gluteal muscle exercise regimen ascompared to the conventional protocol for Down syndrome and develop the most efficient treatment protocol forchildren with down syndrome.Materials and Methods: Twelve children with Down syndrome received 8 weeks of continuous therapy, dividedinto conventional and Gluteal muscle exercise regimen groups using randomization. Pre and post-treatmentlevels of functional movement and posture were recorded and analyzed using GMFM and Posture Screen MobilePosture Assessment.Results: The Glutes group showed higher mean GMFM scores and better improvement in posture in 67% of the 6comparisons, while the remaining subjects didn’t show any notable difference.Conclusion: The gluteal muscle exercise regimen group demonstrated more remarkable improvement than theconventional exercise group in both functional movement and posture in children with downs syndrome in a 8week protocol.

Screening and detection of posture defects in children

With the increasing incidence of posture defects in children and adolescents, screening of children's postures in early school periods and in the second stage of education, which is carried out, among others during routine visits to the doctor and during the balance sheet examination, is gaining significance. Early detection of the defect, at the stage of functional changes, enables full recovery, using non-invasive methods, prevents the formation of secondary changes and protects against their consequences, which significantly improves the comfort and quality of life in adulthood

The Use of Visual Analysis for Gait and Foot Posture in Children with Developmental Dysplasia of the Hip

Developmental dysplasia of the hip (DDH) is recognized as a leading cause of significant long-term complications, including inaccurate gait patterns, persistent pain, and early regressive joint disorder, and it can influence families functionally, socially, and psychologically. This study aimed to determine foot posture and gait analysis across patients with developmental hip dysplasia. We retrospectively reviewed participants referred to the pediatric rehabilitation department of KASCH from the orthopedic clinic between 2016 and 2022 (patients born 2016-2022) with DDH for conservative brace treatment. The foot postural index for the right foot showed a mean of 5.89 (n = 203, SD 4.15) and the left food showed a mean of 5.94 (n = 203, SD 4.19). The gait analysis mean was 6.44 (n = 406, SD 3.84). The right lower limb mean was 6.41 (n = 203, SD 3.78), and the left lower limb mean was 6.47 (n = 203, SD 3.91). The correlation for general gait analysis was r = 0.93, presenting the very high impact of DDH on gait. Significant correlation results were found between the right (r = 0.97) and left (r = 0.25) lower limbs. Variation between the right and left lower limb p-values was 0.88 (p < 0.05). DDH affects the left lower limb more than the right during gait. We conclude that there is a higher risk of developing foot pronation on the left side, which is altered by DDH. Gait analysis has shown that DDH affects the right lower limb more than the left. The results of the gait analysis showed gait deviation in the sagittal mid- and late stance phases.

Changes in body posture parameters: a four-year follow-up study

Body posture is an alignment of its segments relative to each other in a certain way and the relations between them. Abnormalities in the alignment of body segments or the cooperation of systems may cause postural defects. Scientific evidence showed that children of school age are more exposed to abnormalities in body posture so posture should be monitored because it is a key aspect of their body's physical health. This study aimed to evaluate changes in body posture parameters in the frontal plane in the same children at 5 and then 9 years of age. This four-year follow-up study included 67 children (29 girls and 38 boys) in preschool-age and school-age phases (the first examination at 5 years of age and the second examination at 9 years of age). Measurements of body weight and height were recorded. The computerized assessment of body posture was performed with the photogrammetric method (MORA 4 Generation). The normality of the distribution of variables was assessed with the Shapiro-Wilk test. Analysis of qualitative data was carried out using Pearson’s chi-squared test. The highest percentage of children were characterized by the deterioration in the position of the lower corners of the scapulae, taking into account the division into sex (respectively in girls 51.7 % and boys 50.0 %) and the analysis of the whole group (50.7 %). There were statistically significant differences in the position of the lower corners of scapulae (UL) between the first and second examinations in all examined children (p = 0.005). The difference in the height of the waist and in the position of the shoulders improved and deteriorated in a similar percentage in children (above 30-40 %). Generally, an improvement in body posture was observed, however, the occurred abnormalities of body posture indicate the need to continuously monitor the children's posture and implementation of preventive and corrective measures.

Alignment of the Sternum and Sacrum as a Marker of Sitting Body Posture in Children

An analysis of literature on the methods of assuming a sitting position and the results of our own research indicated the need to search for biomechanical parameters and existing relationships that would enable a description of sitting body posture. The purpose of this paper is to analyze the relationship between the alignment of the body of sternum and sacrum and the changes in the thoracic and lumbar spine curvatures in children. The study involved 113 subjects aged 9-13 years. A planned simultaneous measurement of the angle parameters of the alignment of the body of sternum and sacrum relative to the body's sagittal axis and the angle parameters of the thoracic and lumbar spine curvatures was performed during a single examination session. The proposed markers of alignment in the corrected sitting body posture are characterized by homogeneous results. A high measurement repeatability was observed when determining the corrected body posture in the study setting. It was noted that changes in the alignment of the body of sternum and sacrum resulted in changes in the thoracic kyphosis and lumbar lordosis angle values, which may be an important component of clinical observations of sitting body posture in children. Implementing the body of sternum alignment angle of about 64° relative to the body's sagittal axis in clinical practice as one of the objectives of postural education may be the target solution for sitting body posture correction in children.

Effects of Feedback-Supported Online Training during the Coronavirus Lockdown on Posture in Children and Adolescents.

(1) Background. The coronavirus pandemic had a serious impact on the everyday life of children and young people with sometimes drastic effects on daily physical activity time that could have led to posture imbalances. The aim of the study was to examine whether a six-week, feedback-supported online training programme could improve posture parameters in young soccer players. (2) Methods. Data of 170 adolescent soccer players (age 15.6 ± 1.6 years) were analyzed. A total of 86 soccer players of a youth academy participated in an online training program that included eight exercises twice per week for 45 min (Zoom group). The participants' exercise execution could be monitored and corrected via smartphone or laptop camera. Before and after the training intervention, participants' posture was assessed using photographic analysis. The changes of relevant posture parameters (perpendicular positions of ear, shoulder and hips, pelvic tilt, trunk tilt and sacral angle) were statistically tested by robust mixed ANOVA using trimmed means. Postural parameters were also assessed post hoc at 8-week intervals in a control group of 84 participants of the same age. (3) Results. We found a statistically significant interaction (p &lt; 0.05) between time and group for trunk tilt, head and shoulder protrusion and for hip anteversion in the Zoom group. No changes were found for these parameters in the control group. For pelvic tilt no significant changes were found. (4) Conclusions. Feedback-based online training with two 45 min sessions per week can improve postural parameters in adolescent soccer players over a period of six weeks.

Balance and Posture in Children and Adolescents: A Cross-Sectional Study.

Balance and posture are two topics that have been extensively studied, although with some conflicting findings. Therefore, the aim of this work is to analyze the relationship between the postural angles of the spine in the sagittal plane and the stable static balance. A cross-sectional study was conducted with children and adolescents from schools in northern Portugal in 2019. An online questionnaire was used to characterize the sample and analyze back pain. Spinal postural angle assessment (pelvic, lumbar, and thoracic) was performed using the Spinal Mouse®, while stabilometry assessment was performed using Namrol® Podoprint®. Statistical significance was set as α = 0.05. The results showed that girls have better balance variables. There is a weak correlation between the anthropometric variables with stabilometry variables and the postural angles. This correlation is mostly negative, except for the thoracic spine with anthropometric variables and the lumbar spine with BMI. The results showed that postural angles of the spine are poor predictors of the stabilometric variables. Concerning back pain, increasing the postural angle of the thoracic spine increases the odds ratio of manifestation of back pain by 3%.

Evaluation of Posturometric Parameters in Children and Youth Who Practice Karate: Prospective Cross-Sectional Study.

Reduced physical activity or inappropriate training can cause the development of postural abnormalities. The aim of the present study was to determine the relationship between intensive, controlled physical activity, such as karate, and postural parameters. The study group consisted of 57 young karate competitors aged 9–12 years. The control group included 76 healthy, active children in similar age. The children's posture, activity level, and time in front of electronic devices were evaluated. The following body posture assessments were carried out: Adams' test, evaluation of the plumb line, evaluation of the kyphosis, and lordosis angles using a digital inclinometer and shoulder blade position measurements using a pediscoliometer. In the majority of cases, despite evidence of an increase or decrease in the values of the plumb line and scapulae level, the results were still within the normal ranges. In 71.93% of the examined karate-training children, a decrease in torso rotation was noted. The study revealed a visible difference in postural muscle strength by the Mathiass screening test (P < 0.00001). The children in the control group spent more time in front electronic devices than the karate-training children did (P < 0.007). Postural defects regression was more often observed in the study group than in the controls (P < 10−8). The frequency of postural defects stabilization was also significantly higher in the study group than in the control children (P = 0.001). Conversely, postural defects progression was significantly more frequent in the control group than in young karate competitors (P < 10−8). These differences remained significant in subgroups of girls and boys. Physical activity performed regularly and under the direction of a professional trainer can prevent postural disorders.

Can the Treatment of Dental Malocclusions Affect the Posture in Children?

The aim of this study was to investigate whether the treatment of the dental malocclusions can affect the postural attitude in children. Sixty patients aged 9-12 years in mixed dentition were enrolled. The patients underwent an orthodontic evaluation for dental malocclusion and a postural examination by means of a vertical laser line (VLL) and a stabilometric-baropodometric platform. The children were treated with a functional appliance according to the type of malocclusion for two years. The position of the head and of the atlanto-occipital joint (C0-C1) respects to the VLL, the typologies of podalic support and the distribution of the body weight on the feet were evaluated before and after the orthodontic treatment. A significant correction of the position of the head, with a physiological extension of C0-C1, a significant improvement of the typology of podalic support and a homogeneous distribution of the body weight on the feet were observed after the treatment of the malocclusions. Conclusion; From our results, the treatment of dental malocclusion can contribute to ameliorate the postural attitude in children.

Lung ultrasound vs chest radiography in the diagnosis of children pneumonia

Background:The aim of this meta-analysis was to evaluate the diagnostic value of lung ultrasound (LUS) in comparison to chest radiography (CXR) in children with pneumonia.Methods:Computer-based retrieval was performed on PubMed and EMBASE. Quality was evaluated according to the quality assessment of diagnostic accuracy studies-2, and Meta-Disc was adopted to perform meta-analysis. Heterogeneity was assessed using Q and I2 statistics. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence intervals (CIs) as the primary outcomes were calculated for each index test.Results:Twenty two studies with a total of 2470 patients met the inclusion criteria. Our results showed that the pooled sensitivity, specificity, and DOR for children with pneumonia diagnosed by LUS were 0.95 (95% CI: 0.94 to 0.96), 0.90 (95% CI: 0.87 to 0.92), and 137.49 (95% CI: 60.21 to 313.98), respectively. The pooled sensitivity, specificity, and DOR for pediatric pneumonia diagnosed by CXR was 0.91 (95% CI: 0.90 to 0.93), 1.00 (95% CI: 0.99 to 1.00), and 369.66 (95% CI: 137.14 to 996.47), respectively. Four clinical signs, including pulmonary consolidation, positive air bronchogram, abnormal pleural line, and pleural effusion were most frequently observed using LUS in the screening of children with pneumonia.Conclusions:The available evidence suggests that LUS is a reliable, valuable, and alternative method to CXR for the diagnosis of pediatric pneumonia.

Ocorrência de alterações posturais em crianças e adolescentes dos anos finais do ensino fundamental

Objective: to identify and assess the occurrence of postural changes in children and adolescents,aged 11 to 14, in the final gradesof elementary school. Materials and Methods:an observational,descriptive, cross-sectional study, with quantitative data and samples composed by 24 children and adolescents froma private school in the city of Pirapora -MG. Postural behavior inside and outside theschool environment wasidentified through the application of the Postural Habit Assessment Questionnaire;children's static posture was assessed by means ofphotographs; andsymmetrography and biophotogrammetry analyses were held through Postural Assessmentsoftware tests. Results:good postural staticand dynamic habits in the school environment and a good perception of correct postures,whichmust be adopted standing or sitting, have been reported. However, postureanalysis by means ofthe software revealed the occurrence of scoliosis,being right-convex(50%) the mostfrequent;severe changes in the alignment ofthe shoulder girdle were shown in 41.7% of the sample. Conclusion:good postural habits and correct postural perceptions were reported. Even though, thesample related back pain and experienced similar complaints fromtheirparents at some point in life, in addition to showing static postural changes.

Influence of Dental Malocclusion on Body Posture and Foot Posture in Children: A Cross-Sectional Study.

The number of studies that investigate the correlations between the temporomandibular system and body posture, postural control, or the distribution of plantar pressure has recently been increasing. However, most of the existing information is not conclusive. Therefore, the study objective was to evaluate if the features of dental malocclusion are correlated with body posture alterations at the lower limb level. This is a multicentre cross-sectional study with 289 children (8–14 years). Angle’s molar relation was analysed at the dental level. The postural control and the plantar pressure distribution were recorded via a force platform. Correlation and inferential analysis between the Angle class and the foot’s biomechanics were tested. The centre of gravity is anteriorised in Angle’s Class II in both the molar class (p ≤ 0.001) and the canine class (p ≤ 0.001). Likewise, a relationship was observed between the contact surface and Angle’s classes, being higher in class III than in II (p ≤ 0.001). The plantigrade phase is shortened in Angle’s Class III. A relationship was found between Angle’s Class II and a forward movement of the centre of gravity. No relationship was found between the Foot Posture Index and the truncated scaphoid height and the dental classification. An evident relationship between the gait typology and dental malocclusion was not found.

Physiological Profile Assessment of Posture in Children and Adolescents with Autism Spectrum Disorder and Typically Developing Peers.

A sound postural system requires sensorimotor integration. Evidence suggests that individuals with Autism Spectrum Disorder (ASD) present sensorimotor integration impairments. The Physiological Profile Assessment (PPA) can be used to evaluate postural capacity assessing five physiological subsets (i.e., vision, reaction time, peripheral sensation, lower limb strength, balance); however, no studies applied the PPA in young individuals. Therefore, this study aimed to investigate the PPA in children and adolescents with ASD compared with age-matched typically developing (TD) individuals and examine the relationship between the PPA subset within the ASD and TD participants according to different age groups. Percentiles from the PPA were obtained from the TD children and adolescents (n = 135) for each test. Performances of the individuals with ASD (n = 18) were examined relative to the TD percentiles. ASD participants’ scores were above the 90th percentile (i.e., poor performance) in most sensory, motor and balance parameters. Performance in most of the PPA tests significantly improved with older age in the TD group but not in the ASD group. The study findings support the use of the PPA in TD children and adolescents while further research should investigate postural capacity in a larger ASD sample to enhance the understanding of sensorimotor systems contributing to compromised postural control.

Upper and Lower Limb Strength and Body Posture in Children with Congenital Hypothyroidism: An Observational Case-Control Study.

Background: Congenital hypothyroidism (CH) is an endocrine disease with a precocious significant impairment of growth and neuromotor development. Thyroid hormones are essential for central nervous system development, maturation, and myelination. Furthermore, thyroid hormone deficiency affects the function of several systems, including the musculoskeletal system. The disease has a significant incidence in the general population (1:3000–1:2000 newborns in Italy). The aim of the present study was to evaluate any differences in upper and lower limb strength, body sway, and plantar loading distribution in children with CH compared to healthy children. Methods: In this study, the case group was composed of children with CH (CHG), while the control group included healthy children (CG). Both groups comprised 19 children (CHG: female = 12; CG: female = 9). The maximum isometric handgrip strength and explosive-elastic lower limb strength were assessed with the handgrip test and the Sargent test, respectively. The stabilometric and baropodometric analyses were used to measure the Center of Pressure displacements and the plantar loading distribution between feet, respectively. The differences between groups were analyzed by a univariate analysis of covariance using as covariates weight and height with the significant level set at < 0.05. Results: We found that CHG children were shorter and thinner than CG ones (p < 0.05). No significant difference in the upper and lower limb strength was found between groups. CHG exhibited a significant greater Sway Path Length (p < 0.01) and Ellipse Surface (p < 0.05) than CG. Moreover, CHG displayed an asymmetric plantar loading distribution with a significant lower percentage in the right than in the left foot (p < 0.05). Moreover, a significant lower plantar loading percentage in the right foot of CHG than in the right foot of CG was observed (p < 0.05). Conclusions: These findings seem to suggest that CH does not affect muscle strength in early treated children. However, these patients show poor postural control ability and asymmetric plantar loading distribution. Increasing the physical activity in these children could improve their body posture.