Relevance. Foot deformities are the most common locomotor pathology in children with infantile cerebral paralysis. At the same time many children suffering from this pathology wear standard shoes that do not take into account the individual foot anatomy. Purpose of the study — to justify the expedience of individual approach to orthopaedic support for children with infantile cerebral paralysis. Materials and methods. The authors examined 220 feet in 110 patients aging from 3 to 18 years: 62 patients with spastic form of infantile cerebral paralysis and 48 children who were examined during periodic screening at general education institutions (control group). Clinical examination methods, computerized plantography and podometry by flatbed foot scanning (ventrally, posteriorly, medially) in standing position were used in the present study. Results. Statistically significant variances (p*<0.005) were obtained for 8 indicators of foot deformity in three planes in children with infantile cerebral paralysis as compared to the norm, as well as differences between the groups of patients with varying degree of disorders in gross motor functions. The authors established pathological foot deformities in children with infantile cerebral paralysis; statistically significant variances in types and degrees of these disorders for patient groups with different levels of gross motor functions disorders; distinctiveness of foot deformities within each of the groups. Conclusion. Objectively instrumental method was used to identify the main components of foot deformities in patients with infantile cerebral paralysis with preservation and realization of walking capability: loss of height of longitudinal arches, midfoot pronation and hindfoot valgus, hallux valgus. Increased elevation of longitudinal arches (cavus foot), midfoot supination and hindfoot varus are rarer components of deformities occurring more often in patients with severer forms of the pathology. Strong variation in the spread of foot anatomy parameters observed within different groups of motor dysfunctions indicates the expediency of individual approach to footwear recommendations: standard, less or more complex orthopaedic shoes. Implementation of obtained data into the clinical practice requires additional series of biomechanical trials aimed at elaboration of criteria for recommendations and efficiency evaluation of various footwear types that take into account not only specifics of foot anatomy but also its statodynamic function as well as the level of gross motor functions of a particular patient.

According to the world literature, congenital malformations of the upper limb are found in 2.37.9 per 10 thousand live births, while anomalies in the development of the hand occur in 6595% of patients, the most common are reduction anomalies (brachydactyly, ectrodactyly, adactyly, hypoplasia). Various methods of reconstructive plastic surgery are known in the world literature, including microsurgery, compression-distraction osteosynthesis, various types of skin, tendon-muscle and bone plasty, as well as prosthetics. Non-vascularized toe phalanges transplantation is a less common method, which is effective and technically accessible in case of reduction anomalies of the hand. This study is aimed at studying the relevance of the application of the presented method based on the analysis of world literature. The aim of the review is the analysis of the world experience of using non-vascularized toe phalanges transplantation in case of congenital hand malformations. A search was made for literature sources in the open electronic databases PubMed and eLibrary for the last 110 years. The publications devoted to the study of the effectiveness of transplanting the phalanges of the toes into defects of the fingers in clinical practice are analyzed. This method has a number of advantages: low morbidity for the donor foot, minimal risk of resorption of the transplanted graft, restoration of the anatomy of the formed finger, preservation of blood supply and sensitivity in the formed finger, the possibility of phalanx growth while maintaining the growth zone, the functionality of the fingers. At the same time, such issues as the detailed functioning of the growth zone of the non-perfusion phalanx after its transplantation, the reasons for the continuation or cessation of growth in the short term after surgery, the resorption of displaced phalanges, and the dependence of the mobility of the reconstructed fingers on the technology of interventions are not indicated anywhere. Conducting further research on the role of transplantation of non-vascularized toe phalanges in the pathology of the hand in children seems to be an actual task.

Background. Currently, cerebral palsy is the most common neuromuscular disease in the pediatric population. Spastic forms of cerebral palsy are characterized by secondary musculoskeletal complications. They are corrected by the use of assistive devices and, especially, orthoses, along with surgical treatment, botulinum toxin, and others. Aim. The aim of this study was to assess the type and frequency dynamics of rehabilitation assistive devices in children with spastic forms of cerebral palsy, depending on the level of the gross motor function of the patient. Materials and methods. A prospective analysis was conducted by questioning 214 parents of children with spastic forms of cerebral palsy who were treated for the period from 2017 to 2019. The patients were divided into five groups according to the gross motor function classification (GMFCS). The statistical processing was performed using the application package Statistica 10 and Microsoft Excel. Results. Statistically significant differences in variances (p 0.05) were obtained between the number of rehabilitation assistive devices used in the anamnesis in the year before the questionnaire (period I) and assistive devices used in the last six months before the questionnaire (period II). Repeatedly, patients used orthopedic shoes the most often, and the trunk-hip-knee-ankle-foot orthoses the most rarely. We found five main causes groups of assistive device use failure for children with cerebral palsy. Conclusion. Statistically significant differences in variances were obtained between the frequency of rehabilitation assistive devices used in the anamnesis and during the last six months before the questionnaire was obtained. It has been confirmed that patients used orthopedic shoes most regularly; of all functional orthoses, hip adductor orthosis was used most often repeatedly, whereas the trunk-hip-knee-foot orthoses were the least common. Factors such as a negative attitude of the child towards the orthosis, uncomfortable in life, the presence of construction errors of the product, the absence of appropriate appointments in the individual rehabilitation and habilitation programs for the patient, have led to the most frequent rejection of the reuse of the technical device for rehabilitation. At the same time, positive or negative dynamics on the condition of the patient affected the regularity of the use of a technical device for rehabilitation in only one in six patients.

Relevance. The main direction of rehabilitation of children with cerebral palsy is the preservation and enhancement of the existing level of support and locomotion, as well as compensation of its impairment through various methods of rehabilitation. For an adequate prescription and reliable assessment of these measures effectiveness, it is necessary to use objective indicators of functional impairment characteristic of cerebral palsy. The purpose of this study was to substantiate objective biomechanical indicators of functional impairment in children with cerebral palsy based on the analysis of the interzonal distribution of the load on the foot during walking, taking into account the level of global motor functions impairment. Materials and Methods. 47 children with cerebral palsy at the GMFCS levels of impairment 1 to 3 were examined. The control group consisted of 14 children without anatomical and functional signs of support and locomotion system impairment. Biomechanical examination was performed on the complex «DiaSled-M-Scan» with matrix plantar pressure meters in the form of insoles. The statistical analysis of the data was carried out by nonparametric methods using the SPSS for Widows software. Results. The analysis of the anatomical and functional impairment of 94 feet of the children with cerebral palsy and 28 feet of the control group revealed differences in the interzonal distribution of the load under the feet in six variables (p from <0.001 to 0.003). The most typical were: an increase in the toe-to-heel load ratio (on average by 80%), an increase in the load on the arch (by 49%), and a decrease in the medio-lateral load ratio on the toe (by 37%). For GMFCS 1 patients, a significant indicator of impairment was an increase in the partial load on the arch, for GMFCS 2 and 3 patients — a decrease in the load on the heel and an increase it under the toe. This leads to an increase in the toe-to-heel load ratio. Conclusion. It is advisable to use the revealed indicators of roll-over-the-foot impairment in the functional diagnosis of the condition and in assessing the effectiveness of rehabilitation of children with cerebral palsy.