r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2023-28-4-35-42r-n-j-453Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯ И НАБЛЮДЕНИЯCLINICAL RESEARCH AND SURVEILLANCEОценка биомеханических параметров стоп у больных рассеянным склерозом во время ходьбыAssessment of biomechanical parameters of feet in patients with multiple sclerosis during walkingДороховА. Д.DorokhovA. D.

Дорохов Артемий Дмитриевич

Санкт-Петербург

St. Petersburg

dorohovart@yandex.ruhttps://orcid.org/0000-0002-0201-0136ИвашковаЕ. В.IvashkovaE. V.

Санкт-Петербург

St. Petersburg

ivashkova@ihb.spb.ruhttps://orcid.org/0000-0002-9822-5982ИльвесА. Г.IlvesA. G.

Санкт-Петербург

St. Petersburg

ailves@ihb.spb.ruhttps://orcid.org/0000-0002-7183-9116МинеевК. К.MineevK. K.

Санкт-Петербург

St. Petersburg

mineev@ihb.spb.ruhttps://orcid.org/0000-0002-1497-7109НегорееваИ. Г.NegoreevaI. G.

 Санкт-Петербург

St. Petersburg

nip@ihb.spb.ruhttps://orcid.org/0000-0001-9648-5492ПетровА. М.PetrovA. M.

 Санкт-Петербург

St. Petersburg

apetrov@ihb.spb.ruhttps://orcid.org/0000-0002-4776-2999ПраховаЛ. Н.PrakhovaL. N.

Санкт-Петербург

St. Petersburg

l.n.prakhova@hotmail.comhttps://orcid.org/0000-0001-8154-9107СтоляровИ. Д.StolyarovI. D.

Санкт-Петербург

St. Petersburg

sid@ihb.spb.ruhttps://orcid.org/0000-0001-7175-668XШкильнюкГ. Г.ShkilnyukG. G.

 Санкт-Петербург

St. Petersburg

galinakima@mail.ruТартаковскийВ. Н.TartakovskiyV. N.

 Санкт-Петербург

St. Petersburg

miamy2014@google.comhttps://orcid.org/0000-0001-6684-0422ЦветковаТ. Л.TcvetkovaT. L.

Санкт-Петербург

St. Petersburg

tatianatsvetkova@inbox.ruЗубаревВ. А.ZubarevV. A.

 Санкт-Петербург

St. Petersburg

vadim_zubarev@mail.ruФГБУН Институт мозга человека им. Н.П. Бехтеревой РАН; СПб ГУП «Пассажиравтотранс», медико-санитарная часть №70РоссияN.P. Beсhtereva Institute of Human Brain of the Russian Academy of Sciences; State Unitary Enterprise “Passagiravtotrans” Medical and sanitary unit No. 70Russian FederationФГБУН Институт мозга человека им. Н.П. Бехтеревой РАНРоссияN.P. Beсhtereva Institute of Human Brain of the Russian Academy of SciencesRussian FederationООО «Новел СПб»РоссияNovel SPb LLCRussian FederationСПб ГУП «Пассажиравтотранс», медико-санитарная часть №70РоссияState Unitary Enterprise “Passagiravtotrans” Medical and sanitary unit No. 70Russian Federation2023021020232843542Copyright © Дорохов А.Д., Ивашкова Е.В., Ильвес А.Г., Минеев К.К., Негореева И.Г., Петров А.М., Прахова Л.Н., Столяров И.Д., Шкильнюк Г.Г., Тартаковский В.Н., Цветкова Т.Л., Зубарев В.А., 20232023Дорохов А.Д., Ивашкова Е.В., Ильвес А.Г., Минеев К.К., Негореева И.Г., Петров А.М., Прахова Л.Н., Столяров И.Д., Шкильнюк Г.Г., Тартаковский В.Н., Цветкова Т.Л., Зубарев В.А.Dorokhov A.D., Ivashkova E.V., Ilves A.G., Mineev K.K., Negoreeva I.G., Petrov A.M., Prakhova L.N., Stolyarov I.D., Shkilnyuk G.G., Tartakovskiy V.N., Tcvetkova T.L., Zubarev V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/453

Обоснование. При рассеянном склерозе (РС) отмечаются нарушения ходьбы и равновесия, изменены кинематика мышц стопы и стереотипы ходьбы.Цель исследования. Провести оценку биомеханических параметров стоп у больных РС с различной тяжестью заболевания во время ходьбы.Материал и методы. Анализ данных 102 пациентов с ремиттирующим РС проводился в двух группах, разделенных в зависимости от балла по расширенной шкале инвалидизации EDSS. Распределение плантарного давления измерялось на педографической платформе emed, novel gmbh, Мюнхен, Германия, с использованием протокола, при котором прохождение по платформе начинается с первого шага.Результаты. Больные РС при ходьбе менее нагружают пятку, область центральных плюсневых костей и больше нагружают пальцы. Установлены отличия для коэффициента распластанности (отношение ширины к длине стопы), динамическая ширина стопы у пациентов с баллом по шкале EDSS ≥ 4 значимо меньше как в подъеме, так и в среднем отделе стопы, и в самом узком месте, что приводит к уменьшению площади контакта.Показано, что мобильные или передвигающиеся без посторонней помощи пациенты чаще имеют «полую»  стопу по сравнению с больными РС с незначительными нарушениями. Нагрузка медиальной части стопы больше, чем латеральной, что свидетельствует о преобладании вальгусной стопы. Индекс пронации-супинации значимо больше у больных с умеренными нарушениями в заключительной фазе отрыва пальцев от опоры.Заключение. Оценка деформации стоп на основе измерения биомеханических параметров распределения плантарного давления дает возможность планировать лечебную и реабилитационную тактику при РС.

Rationale. Walking and balance disorders, modi fi ed foot muscles kinematics and walking stereotypes are typical for the patients with Multiple Sclerosis (MS).Objective. To assess the biomechanical parameters of the feet in MS patients with diff erent neurological status during walking.Material and methods. Data analysis of 102 patients with relapsing-remitting MS was carried out for two groups depending on the value of the Expanded Disability Status Scale (EDSS). Plantar pressure distribution was measured on with the pedographic platform emed, novel gmbh, Munich, Germany, using a “fi rst step” protocol.Results and conclusion. Loading of the heel, the area of central metatarsal heads is decreased and loading of the toes is increased during walking in MS patients. Diff erences were found for the spreading coeffi cient (the ratio of the width to the length of the foot), the dynamic width of the foot in patients with an EDSS ≥ 4 is signi fi cantly less in the instep, in the middle and in the narrowest parts of the foot, which leads to the decrease of the contact area. It has been shown that patients with MS who are mobile or walk without assistance are more likely to have pes cavus foot compared to MS patients with minor impairments. The load of the medial side of the foot is greater than the lateral side, which indicates the predominance of the valgus foot. The pronation-supination index is signi fi cantly higher in the patients with moderate impairments in toe-off phase. Evaluation of foot deformity based on the measurement of biomechanical parameters of plantar pressure distribution makes it possible to plan the treatment and rehabilitation tactics in MS patients.

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The authors declare that there are no conflicts of interest present.