Impaired supporting function of the feet in adolescents with congenital cleft lip and palate with a mesial ratio of dentition

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BACKGROUND: Impaired occlusal relationships of dental rows can cause adaptive changes in the entire musculoskeletal system, including the feet. Thus, studying the biomechanics of the feet with the possibility of changing the medical rehabilitation program of patients with dentomaxillofacial anomalies of various geneses is important.

AIM: To investigate the plantographic characteristics of the feet in adolescents with congenital cleft lip and palate and combined dentomaxillofacial anomaly with a mesial ratio of dental rows and analyze patterns of distribution of plantar pressure before and after reconstructive operations on the jaws and restoration of facial harmony.

MATERIALS AND METHODS: The study included 31 patients of both sexes aged 15–17 years, who were divided into two groups. The first group consisted of 15 patients with congenital cleft lip and palate after the early stages of reconstructive surgery (cheilorhinoplasty and uranoplasty) and developed a combined dentomaxillofacial anomaly. The second group, with milder lesion, included 16 patients with combined dentomaxillofacial anomaly and do not have congenital cleft lip and palate. Patients had skeletal forms of mesial ratios of dental rows. To correct the bite and restore the aesthetics of the face, all patients underwent simultaneous bone reconstructive (“orthognathic”) surgery on the upper and lower jaws, including genioplasty in some of them, to restore the normal relationship of the jaw bones and harmonize the face. The plantographic characteristics of the feet were studied in patients before surgery and 1–6 months after surgery. The results of these two groups were compared with a pantographic examination of 18 healthy children (control group) without these pathologies in the maxillofacial region and without impairment of the supporting function of the foot.

RESULTS: The first and second groups had a significant decrease in the indices of support on both feet before surgery: t, up to 85 (normal, 96); m, up to 16 (normal, 23); and s, up to 20 (normal, 24), which indicate a decrease in the spring function of the transverse and longitudinal arches and impairment of the supporting function of the feet. It was most pronounced in patients with congenital cleft lip and palate. Deviations in the magnitude of the Clark angle α were multidirectional on the left and right feet, which indicated an abnormally high asymmetry of the load distribution between the feet. Functional relationships between the foot arches were pathologically enhanced to values of rs = 0.83 (normal, rs = 0.14), which indicated a formed pathological support strategy of the feet. After reconstructive operations on the jaws, the biomechanics of the feet in patients with combined dentomaxillofacial anomaly (without congenital cleft lip and palate) tended to normalize.

CONCLUSIONS: It is necessary to consider the possible aggravating effect of the feet with a modified support strategy on the condition of the dentofacial area. Moreover, the comprehensive diagnosis plan of adolescents with congenital cleft lip and palate and combined dentomaxillofacial anomaly and combined dentomaxillofacial anomaly (without congenital cleft lip and palate) should include a study of the supporting function of the feet, considering rehabilitation measures to correct the distribution of plantar pressure.

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About the authors

Igor E. Nikityuk

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Author for correspondence.
ORCID iD: 0000-0001-5546-2729
SPIN-code: 5901-2048
Scopus Author ID: 57190070174

MD, PhD, Cand. Sci. (Med.)
Russian Federation, Saint Petersburg

Mikhail G. Semenov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov

ORCID iD: 0000-0002-1295-1554
SPIN-code: 2603-1085
Scopus Author ID: 57193276067

MD, PhD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Sofia A. Botsarova

North-Western State Medical University named after I.I. Mechnikov

ORCID iD: 0000-0002-4675-8517
SPIN-code: 4930-8561

MD, resident

Russian Federation, Saint Petersburg


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Supplementary files

Supplementary Files
1. Fig. 1. Appearance and computed tomography of the skull of group 1 and 2 patients before osteoreconstructive surgeries on the jaws: a, patient S., 16 years old, with congenital cleft lip and palate and combined dentomaxillofacial anomaly after staged cheilorhinoplasty and uranoplasty; b, patient K., 16 years old, with combined dentofacial anomaly (without congenital cleft lip and palate)

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2. Fig. 2. Appearance and computed tomography of the skull of patient Z., 17 years old, with congenital cleft lip and palate and combined dentomaxillofacial anomaly before (a) and 3 months after (b) LeFort I maxillary osteotomy, bilateral retromolar sagittal mandibular osteotomy, and genioplasty

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3. Fig. 3. Plantographic examination of the patients: a, scanning of the plantar surface of the feet; b, calculation of plantogram linear parameters; c, calculation of the angular parameter of the plantogram, Clarke’s angle (α)

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4. Fig. 4. Plantograms of the feet of patient K., 17 years old, with a combined dentomaxillofacial anomaly (without congenital cleft lip and palate): a, before the surgery, the support ability of the head of metatarsal bone I is reduced on both sides, more on the right (supination rigidity of the forefoot); b, one month after the surgery, the support ability of the head of metatarsal bone I on both sides improved (supination rigidity of the forefoot was eliminated)

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5. Fig. 5. Computer statokinesiograms: a, healthy adolescent, 16 years old; b, patient F., 17 years old, with congenital cleft lip and palate, combined dentomaxillofacial anomaly, pronounced disposition of the patient’s real center of pressure in relation to the absolute center posteriorly before surgery; c, the same patient after surgery, a significant displacement of the real center of pressure of the adolescent anteriorly into the projection of the absolute center. The red line is the test with eyes open, and the green line is with eyes closed

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6. Fig. 6. Regression line (bold) and its confidence interval (thin lines) to assess the relationship between the medial m and median s support indices of the left foot with a double-support load: a, in the healthy group; b, in patients with congenital cleft lip and palate and combined dentomaxillofacial anomaly after the surgery

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Copyright (c) 2022 Nikityuk I.E., Semenov M.G., Botsarova S.A.

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