Neurodevelopmental disabilities in children with Down syndrome include ligamentous laxity, muscle hypotonia, lack of postural stability and joint hypermobility; all of which create secondary functional problems in the lower extremity that lead to deviations in gait.
This was analysed in further detail by Galli et al. who observed that a combination of these abnormalities contributed to impediments in dynamic joint stabilisation and an increased incidence of musculoskeletal deformities in children with Down syndrome.
The authors noted that in order to compensate for muscular and ligamentous dysfunctions, patients altered their gait patterns leading to shorter strides, increased knee flexion at initial contact, increased hip flexion and increased plantar flexion of the ankle.
These kinematic modifications imply an overall weakness in the functionality of the muscles, causing an increase in joint stiffness to compensate for this weakness.
A physical examination of 50 children with Down syndrome by Concolino et al. revealed the presence of several conditions of the lower limbs – pes planus, fissures, split toenails and abnormal pressure sites – occurring secondary mostly to hypotonia and ligamentous laxity.
This emphasises the need for regular podiatric examinations for the early detection and treatment of minor orthopaedic alterations such as pes planus which could become severe and affect the motor capabilities of children with Down syndrome, if left untreated for an extended period of time.
In an article published in Lower Extremity Review by Julia Looper, assistant professor in the Physical Therapy Programme at the University of Puget Sound, the benefits of an orthotic inclusion in treatment modalities are documented to be more significant in children with Down syndrome who have an established walking pattern.
Looper suggests providing an orthotic device that does not unnecessarily limit movement across a joint as this has the potential for creating a negative impact on neuromotor development.
The global physical characteristics of the child such as height, weight and overall hypermobility need to be considered in the manufacture of the orthotics, as these are more related to gait parameters than specific biomechanical measurements like foot parameters.
In order to improve the quality of life of these children and to prevent surgical interventions at a later stage, conservative approaches in the form of customised foot orthotics such as MASS4D® and/or physical therapy treatment need to be adopted early on to improve the physical development of a child with Down syndrome.
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A common paediatric foot condition called Calcaneal apophysitis, or Sever’s disease, has a clinical presentation that includes posterior heel pain on medial and lateral compression with the prevalence of mild swelling in some cases.