Date of Paper/Work

4-2016

Type of Paper/Work

Research Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Laura Gilchrist

Second Advisor

David Chapman

Abstract

Background

Physical therapists have recognized a potential change in foot structure among pediatric cancer patients undergoing chemotherapy; however it has not been empirically investigated.

Purpose

The purpose of this study was to determine if patients with chemotherapeutic induced peripheral neuropathy (CIPN) develop foot posture abnormalities when compared to gender and age matched controls. We hypothesized that patients with CIPN, especially distal motor CIPN, or ankle ROM limitations demonstrate foot posture abnormalities.

Methods

The medial and posterior foot aspects of pediatric cancer patients (n=38) and age and gender matched controls (n=38) were digitally photographed in a standard position while bearing weight. MMT of great toe extension (GTE) and ankle dorsiflexion (DF), PROM of ankle DF, and peripheral nerve function (using the ped-mTNS) was measured for all subjects. Photographs were analyzed using four aspects of the Foot Posture Index (FPI), calcaneal tilt angle, navicular height, and medial longitudinal arch angle. Independent sample T-test and Mann-Whitney U were used to compare group’s foot measures. Spearman correlation statistic was used to determine associations between strength or ROM measures and foot posture.

Results

Subjects’ mean age was 11 years (range 5-18) and 37% of the population was male. Children undergoing cancer treatment had higher scores on the ped-mTNS (10.5 vs. 0.7, p<0.001), limited ankle DF PROM (Right 8.3 vs 14.2 degrees, p<0.001, Left 8.5 vs 14.3 degrees, p<0.001), and decreased strength (right GTE median 3 vs 5 p<0.001, right ankle DF 4 vs 5 p<0.001). No significant differences were found between groups in foot posture measurements. A modest, but significant, correlation was found between L GTE strength, total FPI on the left foot (rS=0.29, p=0.01), and left calcaneal tilt angle (rS=0.27, p=0.02). Right ankle DF PROM was only correlated to right navicular height (rS=-0.25, p=0.04).

Conclusion

Our data do not support the hypothesis that a difference in foot posture between pediatric cancer patients and healthy controls exists. Although chemotherapy is linked to foot muscular weakness and limited ankle ROM, it was not shown to be strongly correlated to structural changes in foot posture. Limitations of this study include use of a modified FPI and possible impact of PT intervention.

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