title: Crouch gait changes after planovalgus foot deformity correction in ambulatory children with cerebral palsy.
abstract: Ambulatory children with cerebral palsy (CP) may present with several gait patterns due to muscular spasticity, commonly with crouch gait. Several factors may contribute to continuous knee flexion during gait, including hamstring and gastrocnemius contracture. In planovalgus foot deformity, the combination of heel equinus, talonavicular joint dislocation, midfoot break and external tibial torsion also contribute to crouch gait as part of lever arm dysfunction. In this retrospective cohort study, we assessed 21 children with CP (34 feet) who underwent planovalgus foot correction as a single level surgery. Fifteen feet underwent subtalar fusion and 19 feet had lateral calcaneal lengthening. Patients who underwent knee, hip or pelvis surgeries were excluded from the study. The aim was to examine the changes in gait pattern and the correlation between the changes of knee flexion at stance phase with the other kinematic and kinetic parameters after foot surgery. Post surgery change of Maximum knee extension at stance (MKE-dif) was the outcome of interest. The magnitude of change in MKE after surgery increased (less crouch after surgery) in patients who had milder preoperative planovalgus feet and higher preoperative ankle maximum dorsiflexion at stance and ankle power. The gain of knee extension after surgery correlated with correction of ankle hyperdorsiflexion and with increase of knee extension at initial contact and knee power. Patients with high preoperative ankle maximum dorsiflexion may benefit from surgical foot deformity correction to achieve decreased ankle dorsiflexion with no knee surgical intervention.
authors: Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
authors: Muayad
authors: M
authors: Kadhim
authors: Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA. Electronic address: fmiller@nemours.org.
authors: Freeman
authors: F
authors: Miller
mesh_terms: D000293:Adolescent; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery; D001696:Biomechanical Phenomena; D001852:Bone Lengthening / Q000379:methods; D002111:Calcaneus / Q000503:physiopathology / Q000601:surgery; D002547:Cerebral Palsy / Q000503:physiopathology* / Q000601:surgery* / Q000628:therapy; D002648:Child; D005260:Female; D005528:Foot / Q000503:physiopathology / Q000601:surgery; D005530:Foot Deformities / Q000503:physiopathology* / Q000601:surgery* / Q000628:therapy; D005684:Gait / Q000502:physiology*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D009128:Muscle Spasticity / Q000503:physiopathology / Q000628:therapy; D018482:Muscle, Skeletal / Q000503:physiopathology; D019637:Orthopedic Procedures; D011187:Posture / Q000502:physiology; D012189:Retrospective Studies; D016138:Walking / Q000502:physiology
keywords: Calcaneal lengthening; Cerebral palsy; Crouch gait; Pes planovalgus; Subtalar fusion