| Introduction |
 Three main gait disorders seen with cerebral palsy include
- Toe-walking gait
- Crouched gait
- Stiff-knee gait
- Gait analysis has helped identify distinct problems and guide orthopaedic treatment
|
| Toe Walking |
- Introduction
- Treatment
- ankle foot orthosis
- indications
- flexible deformities - foot is passively correctable to neutral
- technique
- posterior leaf-spring orthoses used in presence of excessive ankle plantar flexion in the swing phase
- tendo-achilles lengthening
- indications
- rigid deformities - foot is not passively correctable to neutral
- technique
- gastrocnemius recession vs tendo-achilles lengthening
- Silfverskiöld test distinguishes between contracture of gastrocnemius only versus combined gastrocnemius and soleus
- intra-operative goal is to obtain 10 degrees of dorsiflexion
|
| Crouched Gait |
- Introduction
- common in diplegic CP
- hamstring contracture - most common cause
- results in a combination of hip flexion, knee flexion, and ankle equinus
- Treatment
- multiple simultaneous soft tissue releases (hip, knee, ankle)
- technique
- CAUTION - isolated heel cord lengthening in the presence of tight hamstrings and hip flexors will lead to progressive flexion at the hips and knees, thus worsening the crouched gait
- complications
- hamstring contracture most likely to recur
- elongated patellar tendon (patellar alta) is another complication of this condition that is difficult to treat
|
| Stiff-Knee Gait |
- Introduction
- common in spastic diplegic CP
- characterized by limited knee flexion in swing phase due to rectus femoris firing out of phase (seen on EMG)
- Evaluation
- instrumented gait analysis shows quadriceps activity from terminal stance throughout swing phase
- Treatment
- transfer of distal rectus femoris tendon
|
|
Please Rate Educational Value!
|
3.0
t-4128
|
Average 3.0 of 10 Ratings
|
Qbank (1 Questions)
TAG
(OBQ08.184)
A posterior leaf spring ankle-foot orthosis would be appropriate for which foot and ankle malalignment pattern in a child with spastic-type cerebral palsy?
Review Topic
DISCUSSION:
Specific indications for the different orthoses used to improve gait in cerebral palsy may vary among providers. Davids et al discuss these indications in their review article. The authors state that the factors that make the posterior leaf spring ankle-foot orthosis (PLSO), shown in Illustration A, most appropriate are the clinical presence of absent heel strike and minimal (but some) dorsiflexion. The PLSO is designed to control excessive ankle plantar flexion in the swing phase and allow ankle dorsiflexion in midstance. A solid AFO(Illustration B) is both a stance and swing-phase control orthosis, which can help with excessive ankle dorsiflexion in midstance. A crouch gait pattern may attempt to be treated with a floor-reaction AFO (Illustration C), and a knee-ankle-foot orthoses(Illustration D) is useful for maintaining knee position and stability in children who primarily stand, and are minimally ambulatory. Supramalleolar orthoses(Illustration E) are used to control flexible coronal plane deformities, such as excessive supination or pronation of the hindfoot.
REFERENCES:
1.
Davids JR, Rowan F, Davis RB. Indications for orthoses to improve gait in children with cerebral palsy. J Am Acad Orthop Surg. 2007 Mar;15(3):178-88. Review.
PMID:17341675 (Link to Abstract)
|
Please Rate Educational Value!
|
4.0
q-570
|
Average 4.0 of 14 Ratings
|
Related Cases
|
HPI -
A 2.5 years old male presents with this gait abnormality. He has flexion deformi...
What is the most likely diagnosis?
|
2 weeks ago
89
responses
|
Videos
|
Video of a crouched gait in a quadriplegic spastic cerebral palsy patient
|
1/21/2012
796 views
|
|
spastic diplegic cerebral palsy toe walking gait
|
1/21/2012
716 views
|
See More Videos
Level of Evidence 5 and Other Journal Articles (includes Case Reports, Expert Opinions,
Personal Observations, and Biomechanic Studies)
-
Davids JR, Rowan F, Davis RB. Indications for orthoses to improve gait in children with cerebral palsy. J Am Acad Orthop Surg. 2007 Mar;15(3):178-88. Review.
PMID:17341675 (Link to Abstract)
Textbooks
- Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
- AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
- Orthopaedic Knowledge Update 10, John M Flyn. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2011
- Hoppenfeld SP. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lipponcott, Williams, and Wilkins, Philadelphia, PA, Copyright 2009
- Orthopaedic In-training Examination (OITE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
- Self-Assessment Examination (SAE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Page:1