Cerebral Palsy Gait Disorders

Topic updated on 03/08/16 6:51pm
  • Cerebral Palsy General 
  • Three main gait disorders seen with cerebral palsy include
    • Toe-walking and Jump gait
    • Crouched gait
    • Stiff-knee gait
  • Gait analysis has helped identify distinct problems and guide orthopaedic treatment 
  • Gait developmental milestones
    • independent gait expected between 12 to 18 months old in non-CP children 
Toe Walking 
  • Introduction 
    • common in hemiplegics 
  • 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 


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Qbank (3 Questions)

(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? Topic Review Topic

1. Absent heel strike, excessive plantar flexion in the swing phase, and 5 degrees of passive ankle dorsiflexion
2. Excessive ankle dorsiflexion in midstance caused by incompetence of the ankle plantar flexors
3. Crouch gait pattern with excessive ankle dorsiflexion, increased knee flexion, and increased hip flexion in midstance
4. Excessive supination of the hindfoot during stance, which is passively correctable
5. Significant knee instability and weakness with stance in a child who is minimally ambulatory

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Video of a crouched gait in a quadriplegic spastic cerebral palsy patient
spastic diplegic cerebral palsy toe walking gait
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