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Unilateral cross-bite and possible interrelations with the loading of the foot in the stance phase

Journal: Unpublished MSc thesis Wiener Schule für Osteopathie, Date: 2009/12, Pages: 65, type of study: clinical trial

Free full text   (https://www.osteopathicresearch.org/s/orw/item/2909)

Keywords:

unilateral cross-bite [1]
stance phase [1]
foot [54]
children [228]
clinical trial [612]
WSO [433]

Abstract:

Study Design: The aim of the study is to evaluate whether there is a correlation between a unilateral cross-bite and the loading of the foot during the stance phase. More precisely, the study looks at whether there is a difference between the loading of the left and the right foot of the test persons in the study and the control groups. In the case of an asymmetry in the loading of the feet in the study group (cross-bite group) a correlation analysis helps to find out whether this asymmetry correlates with the presence of the bite anomaly “unilateral cross-bite”. The present study is a fundamental study with at least ten test persons with a normal occlusion in the control group and at least ten test persons with a unilateral cross-bite diagnosed according to orthodontic classification criteria in the study group. In order to determine the parameters that are to be examined a pilot study is implemented beforehand where various measurements are carried out among three children per group. Outline/Problem Definition When my son Simon was diagnosed with bilateral pes valgus and two years later with a cross-bite, my interest in the topic: “Unilateral cross-bite and possible interrelations with the loading of the foot in the stance phase” was raised. Among the patients in my osteopathic practice I treat a number of children who come to see me because of problems related to the position of their feet. In many cases the case history shows that these children often also have problems with a faulty position of their teeth. Equally, I can often observe that children with problems of malocclusion load their feet in a way that deviates from the physiological loading pattern. Could it be that these problems are interrelated? I could not let go of this question anymore. Research Question & Objective Can interrelations between a unilateral cross-bite and the loading of the foot in the stance phase be identified? Therefore the aim of the present study is to evaluate the above-mentioned possible interrelations in order to confirm the following hypothesis: In the case of the diagnosed bite anomaly “unilateral cross-bite” correlations with alterations of the loading of the foot during the stance phase can be observed. Hypothesis 1.Part Zero hypothesis: In the stance phase no difference in the loading of the feet can be observed in the groups “unilateral cross-bite left” and “normal bite”. Alternative hypothesis: In the stance phase a difference in the loading of the left and the right foot can be observed in the “unilateral cross-bite left” group in comparison to the “normal bite group”. 2.Part Zero hypothesis: No statistical correlation can be identified between the bite anomaly ‘unilateral cross-bite left’ and a unilateral loading of the foot during the stance phase. Alternative hypothesis: During the stance phase a correlation between the bite anomaly ‘unilateral cross-bite left’ and the unilateral loading of the foot can be observed. Relevance for the Patients In addition, a scientific proof of correlations between bite anomalies and problems of the feet could improve an interdisciplinary cooperation in treating such problems, i.e. cooperation between osteopaths and orthodontists, and thus achieve better results for the patients. Relevance for Osteopathy If such correlations between the chewing apparatus and the loading of the feet can be established, this would confirm one of the basic principles of osteopathy: “The body works as a unit”. In addition, a scientific proof of correlations between bite anomalies and problems of the feet could improve an interdisciplinary cooperation in treating such problems, i.e. cooperation between osteopaths and orthodontists, and thus achieve better results for the patients. Methodology In the framework of a fundamental study 20 children, 10 girls (50%) and 10 boys (50%), with an average age of 8.5 (+-1.38) years were examined. 10 children were diagnosed with the orthodontic bite anomaly “unilateral cross-bite left”, which was established through an x-ray examination. The control group consisted of 10 children with a normal bite patter. Their normal occlusion had been diagnosed by inspection through a dentist during a routine dental examination at school. The examination of the loading of the feet was carried out by means of the Pedographie Emed® ST2 (Novell München) system at the regional hospital Rankweil/Vorarlberg (Austria). The measured data was grouped in the Novel database and checked by a one-factor ANOVA analysis. The measured parameters, which showed a significant difference between the right and left side where exported as ASCII file and re-organised in an EXCEL database for the transformation into an SPSS presentation. The normal distribution of the measured data was checked with the Kolmogorov-Smirnov test. The mean value for each side was calculated on the basis of the values measured for each of the five walking attempts. These mean values served as basis for the calculation of the point-biserial coefficient of correlation, Eta. The characteristics ‘cross-bite’ right and ‘normal bite’ were defined as independent variables. Results In the analysis the loading of the left foot was compared with the loading of the right foot within the two groups. The result of the ANOVA calculation shows significant asymmetries in the parameters Instant of Peak Pressure and Force Time Integral Total Object (p = <0.05). The Instant of Peak Pressure on the left side is 40.9 SD +-29.6 % ROP and on the right side 58.4 SD +-30.3 % ROP. The Force Time Integral is 53.4 SD +-7.2 N*s for the left foot and 56.1SD +-7.4 N*s for the right foot. This means that the children of the ‘unilateral cross-bite left’ group reach the maximum pressure much earlier on the left foot, while they load the right foot much more. If the foot is divided into 11 areas by a mask, in particular the lateral midfoot on the right side shows an increased loading in the cross-bite group. A statistical analysis regarding a correlation of the significant parameters with the occlusion pattern did not produce significant results. However, a tendency con be observed regarding the Instant of Peak Pressure on the left side (p=0.056). Critical Reflection/Perspectives/Conclusions A partly highly significant ANOVA result of the parameters Instant of Peak pressure Total Object, Force time integral Total Object, Peak pressure lateral midfoot and Mean pressure lateral midfoot despite a small group size of only ten test persons is quite remarkable. However, these results must not hide the fact that a considerably higher number of test persons would be necessary to make a valuable statement regarding the symmetry of the loading of the feet. This study, however, could not find out what the significant differences can be attributed to. It would be of advantage to carry out further studies to find out in how far the effects of a unilateral cross-bite are compensated. From the perspective of the author and the orthodontist who was involved in the study it would be desirable to examine a larger number of children also with other forms of bite anomalies with regard to their loading of the feet. This could contribute to a better understanding of supposed interrelations and interrelations that are described in the literature This could help a better understanding of possible connections between the occlusion and the feet in general.


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