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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?
Absent heel strike, excessive plantar flexion in the swing phase, and 5 degrees of passive ankle dorsiflexion
Excessive ankle dorsiflexion in midstance caused by incompetence of the ankle plantar flexors
Crouch gait pattern with excessive ankle dorsiflexion, increased knee flexion, and increased hip flexion in midstance
Excessive supination of the hindfoot during stance, which is passively correctable
Significant knee instability and weakness with stance in a child who is minimally ambulatory
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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.
Davids JR, Rowan F, Davis RB.
J Am Acad Orthop Surg. 2007 Mar;15(3):178-88. PMID: 17341675 (Link to Abstract)
HPI - A 2.5 years old male presents with this gait abnormality. He has flexion deformity walking gait in both knees which was first noticed when he started to walk about year ago.
What is the most likely diagnosis?
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HPI - 2yo girl presents with her mother following sudden onset of tip-toe gait 2 days ago.
This is her first episode of tip-toe gait; she was previously ambulating normally.
No history of trauma.
She has hit all relevant milestones; no delay in development.
Had a recent upper respiratory tract infection 1 week earlier, which has resolved.
What is the likely diagnosis?
Video of a crouched gait in a quadriplegic spastic cerebral palsy patient
spastic diplegic cerebral palsy toe walking gait