Efficacy of Taping versus Prefabricated Medical Shoes on Kinematic Gait Parameters in Saudi Children with Down Syndrome

Abstract

Back ground; Down syndrome is a genetic disorder that is caused by an extra chromosome 21 that is present in all or some of the individual's cells . The presence of an extra chromosome in DS gives rise to certain congnitive deficits and results in significant delays in the onset of motor skills, including qualitative differences in movement patterns, compared with the normal children. In Down syndrome an increased incidence of orthopaedic problems is present. Orthopaedic pathology in DS is mostly secondary to hypotonia, ligamentous laxity, and hyperflexibility of the joints.More common orthopaedic problems are of minor severity and generally involve the lower extremities. Flat foot deformity secondary to ligamentous laxity is observed in more than 90% of persons with Down syndrome. Feet play an important role in supporting body weight, reducing the force exerted on lower limbs and related joints, absorbing vibrations, buffering impacts and controlling the balance of body when body is in contact with the ground. Flat foot (Pes planus ) is a condition in which the foot does not have a normal medial longitudinal arch, flat foot is associated with pronated foot. It is widely believed that a person with pes planus and pronation foot has an increased susceptibility to mechanical overloading of their leg and/or foot structures flatfoot. Also, it is not only a static alignment problem of the ankle and foot complex but could be the consequence of a dynamic functional change of the lower extremity . If pronation is diagnosed before the age of five it can usually be treated in such a manner that the bones and joints will be aligned properly as growth continues attributable to the young foot is still largely made of cartilage, with less bone than would be present in the adult foot. Most studies available relative to flat foot and gait in DS children concern the effect of orthotics as conservative treatment for pronation and flatfoot . This study have been use two types of intervention to limited and control the flat feet and pronation in down syndrome to improve gait and avoid problems in prolonged stress situations without the limitation in any activity or interfere in muscles strength . Shoe and Taping are widely used for both foot and ankle problems. Shoe influence in both flat foot and pronation.. A number of studies believe that the medical shoe is most appropriately used for the flexible flat foot children , and found that the medial support in a shoe may provide increased stability to the foot and leg and may reduce the maximal foot pronation. Also , ankle taping can PDF created with pdfFactory trial version www.pdffactory.com be correct malalignment of the foot depends on mechanical and physiological effects by ability of taping to stiffen the ankle joint and limits the hypermobility and improve the gait pattern. Purpose ; was to compare between the instant effect of taping and medical shoes on kinematic gait parameters in Saudi children with down syndrome. Subjects and Methods ; A total of 45 children participated in this study. Thirty children with DS and 15 normal children . Their ages between 3-5 year old. The Down Syndrome children were recruited from The Down syndrome school in Riyadh. All childern were able to walk for at least one year without wearing foot orthoses or any medical shoes. Each child had adequate hindfoot flexibility to be positioned in neutral heel alignment and had excessively pronated feet in standing. Down's Syndrome children were randomly divided into two equal groups. Group A was applied taping and group B was wearing shoes Step length , stride length ,velocity and base of support were measured by using foot print analysis. Results; Statistical analysis showed that walking with tape or shoes have a significant improving in all gait factors (step length , stride length ,velocity and base of support) and no significant differences between those wear shoes and tape. Also, there were no statistically significant differences could be demonstrated at step length and stride length between the normal children and DS only the different was found in velocity and base of supports. Conclusions; it was concluded that walking with tape and wearing shoes have a significant effect in improving in gait parameters in Down Syndrome children.