Updated on
What did the project achieve?
“We now have a much better understanding of why many children with cerebral palsy develop a painful foot deformity – and which factors are most likely to make this problem worse over time,” says Dr Caroline Stewart of the Robert Jones and Agnes Hunt Orthopaedic Hospital in Shropshire. “We hope this knowledge will ultimately lead to more personalised treatments that can help to ease pain, improve mobility and enhance children’s quality of life.”
Cerebral palsy is the most common serious physical disability in childhood. Many children with the condition experience lifelong challenges with movement and muscle control. Even those who are able to walk will often develop an unusual gait that places extra strain on their legs and feet. Over time, these abnormal forces can affect developing bones and joints, leading to a painful foot deformity that can make walking and taking part in everyday activities more difficult.
The researchers developed a new way of examining children’s feet using state-of-the-art technologies to explore how and why foot deformities occur. They recruited 23 children to take part in the study, including 13 with cerebral palsy.
“We used MRI and CT scans to capture highly detailed images of the children’s feet, and also assessed how they walked,” says Dr Stewart. “Using these data, we built personalised computer models of each child’s legs and feet, allowing us to study how their bones, joints and muscles work together during movement.”
The researchers discovered that children with cerebral palsy often have an altered alignment in the joint beneath the ankle that allows side-to-side movement of the foot.
“In children with a foot deformity, this misaligned joint means that when they walk, the forces passing through the foot tend to push it into a more deformed position,” says Dr Stewart. “We also found that the muscles that might normally help prevent these changes are either less able to do so or, in some cases, are even contributing to making the deformity worse.”
As well as providing new insight into the causes of foot deformities, this research has developed promising new assessment tools that could be introduced into routine clinical practice.
“In the future, this approach could be used in the clinic to guide treatment decisions and help identify children who may benefit from early, targeted interventions,” says Dr Stewart. “The goal would be to prevent or slow the progression of foot deformities before they become painful or disabling, improving long-term mobility and quality of life.”
This research was completed on
How are children’s lives affected now?
Cerebral palsy is the most common serious physical disability in children in the UK. Usually caused by damage to a baby’s brain before, during or soon after birth, a child can face lifelong difficulties with their movement and coordination.
“Many children with cerebral palsy will have mobility issues – which range from finding it difficult or painful to walk – to being unable to walk at all,” says Dr Stewart.
Those children who do learn to walk will often have an abnormal gait that puts unusual forces through their legs and feet, which can affect their bones and joints.
“As a result, many children with cerebral palsy develop painful foot deformities that can make walking even more difficult, further reducing their quality of life,” says Dr Stewart. “Although there are potential treatments that might help prevent these problems, we currently find it difficult to predict exactly which children will need help.”
How could this research help?
“Our goal is to understand why foot deformity happens and which children with cerebral palsy are most at risk – paving the way for personalised prevention strategies,” says Dr Stewart.
The researchers are developing a new way of examining children’s feet using state-of-the-art technologies. They plan to recruit 15 children with cerebral palsy and 10 children without cerebral palsy, to take part in the study – taking detailed MRI scans and measurements of how they walk.
“By combining these data, we will construct advanced computational models of the muscles and joints of each child’s ankle and foot,” says Dr Stewart.
Using these models, the team will examine – in unprecedented detail – how a child’s foot shape combines with the forces on their bones and joints.
“Ultimately, this study could lead to effective new ways to prevent a child with cerebral palsy from developing foot deformities – reducing their pain, increasing mobility and enabling participation in a wider range of activities,” says Dr Stewart.
References
- Wimalasundera, N. & Stevenson, V.L., Cerebral palsy. BMJ Practical Neurology 2016; 16:184-194.
- Office for National Statistics. Vital statistics in the UK: births, deaths and marriages – 2018 update. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/vitalstatisticspopulationandhealthreferencetables [website accessed 23 July 2019]
Research table
Project details
| Project Leader | Dr Caroline Stewart, PhD CEng SRCS |
| Location | ORLAU, Robert Jones and Agnes Hunt Orthopaedic Hospital |
| Project Team | Dr Luca Modenese, PhD Dr Julie Stebbins, CSci DPhil SRCS Dr Ed K Chadwick, PhD, BEng Mr Andrew P Roberts, FRCS MD MBChB |
| Other Locations | Department of Civil and Environmental Engineering, Imperial College London Oxford Gait Lab, Oxford University Hospitals NHS Foundation Trust Institute for Science and Technology in Medicine (ISTM), Keele University |
| Grant Awarded | |
| Grant Amount | £148,159 |
| Start Date | |
| End Date | |
| Duration | 24 months |
| Grant Code (GN number) | GN2812 |
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