Funktionelle Evaluation von OP-Verfahren in der Kinderfußchirurgie mittels videogestützter Ganganalyse und Pedobarografie

In pediatric foot surgery there is a risk that even if the surgery went well, there are still functional gait disturbances due to the intervention. If these disturbances are not identified early, they can lead to major complications in motor functions and gait biomechanics during growth. The present work describes the advantages of biomechanical testings in the evaluation of operational results, especially in pediatric foot surgery. The participating research group published studies evaluating the subtalar extra-articular screw arthroereisis indicated for children with juvenile flexible flatfoot. We used pedobarographic investigations, video-based gait analyses, the AOFAS-Score and the VAS-FA in these studies. This cumulative thesis sums up the major results and discusses the usability of the selected examination methods. On average it took four weeks for the children to recover from surgery. After this time we recorded significant improvements in pedobarographic pressure distribution, heel and rearfoot angles collected during gait analysis and in AOFAS-Score. Only the VAS-FA did not improve significantly, even if the mean value was enhanced. In the 1-Year-Follow-up the biomechanical improvements of pedobarography and gait analysis did not change significantly. The results of the AOFAS-Score and the VAS-FA got even better compared the examination four weeks after surgery. Taking a look at the individual development we identified a few patients showing overcorrected or undercorrected angular positions of the foot. These patients were monitored more closely. In one foot where the overcorrection did not normalize and the patient complained about pain at the sinus tarsi, we had to adjust the screw to avoid an early implant removal. Within our research we identified advantages and disadvantages of all our selected examination methods. The pedobarographic investigations were proficient in showing visual changes of the footprints. Certainly, the pedobaroraphy shows difficulties in the diagnosis of the flexible flatfoot. Accordingly, we were not able to determine target values to differentiate between good and less satisfying results of the surgery. The video-based gait analysis provides specific numerical values. Using the normative data from literature we were able to set target corridors to evaluate the surgical results. For a fact, a two-dimensional gait analysis is limited to movements without a lot of joint rotation due to parallax errors. Though, a three-dimensional gait analysis is costly and usually too complex for clinical routine. The AOFAS-Score includes a combination of the sensation of pain and a clinician expertise. Nevertheless, an international validation of the score is missing. The VAS-FA is validated and provides information about the patient reported outcome. In our investigations it correlates well with the dynamic heel and rearfoot angles of the gait analysis. However, the VAS-FA has not been used that much in accordance of the arthroereisis. In conclusion biomechanical testings can provide much beneficial information to evaluate the surgical outcome in the pediatric foot surgery. For the subtalar extra-articular screw artheroereisis we recommend implementing a combination of a two-dimensional gait analysis and the VAS-FA in clinical routine. Other surgical techniques and pathologies might benefit more from different functional analyses.