title: Equinus foot classification in cerebral palsy: an agreement study between clinical and gait analysis assessment.
abstract: BACKGROUND
  Excessive ankle plantar flexion (equinus foot) is a common problem in cerebral palsy (CP) and several treatment options can be considered depending on the equinus type. Few attempts have been made to classify different forms of equinus foot for specific treatment.
  
  
  OBJECTIVE
  This study is aimed at defining equinus foot types in CP patients according to the Ferrari classification, integrating clinical and instrumental assessments. The hypothesis is that clinical differentiation of equinus foot can be evidenced by recurrent anomalies identifiable through gait analysis (GA), which can make the assessment, usually based only on clinician semeiotics, more objective.
  
  
  METHODS
  Clinical and instrumental assessments were performed separately by a senior CP physiatrist and a senior GA physiatrist, the latter was blind to the clinical diagnosis of equinus type.
  
  
  METHODS
  Outpatients
  
  
  METHODS
  Twenty patients, 16 diplegics and 4 hemiplegics (mean age 11 years, SD 4 years 11 months).
  
  
  METHODS
  Clinical assessment by means of Modified Ashworth Scale, Gross Motor Function Measure (GMFM), Observational Gait Analysis (OGA), and measurement of lower limb muscle strength by dynamometer were used to classify the equinus type. Gait analysis assessed the kinematics and EMG of affected lower limbs.
  
  
  RESULTS
  Ten different equinus types were identified. Since various forms of equinus can be present in the same patient, we were able to classify a total of 61 types of equinus in 36 feet. Substantial agreement was found between Clinical and Gait Analysis equinus assignment matched in 50 out of 61 types (Index of agreement with Fleiss' Kappa 79.3 % ). In some case only Gait Analysis was able to identify the equinus type, while in others it did not confirm clinical assignment.
  
  
  CONCLUSIONS
  Gait analysis is able to distinguish different equinus types according to Ferrari classification, making the clinical decision less arbitrary.
  
  
  CONCLUSIONS
  Correct objective diagnosis of equinus foot in CP patients is of paramount importance when choosing suitable rehabilitative interventions.
authors.affiliation: Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy. benedetti@ior.it
authors.forename: M G
authors.initials: MG
authors.lastname: Benedetti
authors.forename: G
authors.initials: G
authors.lastname: D'Apote
authors.forename: S
authors.initials: S
authors.lastname: Faccioli
authors.forename: S
authors.initials: S
authors.lastname: Costi
authors.forename: A
authors.initials: A
authors.lastname: Ferrari
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000150:complications* / Q000534:rehabilitation; D002648:Child; D004576:Electromyography; D004863:Equinus Deformity / Q000145:classification* / Q000150:complications / Q000209:etiology / Q000534:rehabilitation; D005260:Female; D020233:Gait Disorders, Neurologic / Q000145:classification* / Q000209:etiology / Q000534:rehabilitation; D006801:Humans; D007558:Italy; D008297:Male; D055815:Young Adult