title: Evaluation and management of crouch gait.
abstract: OBJECTIVE
  Crouch gait is defined as excessive ankle dorsiflexion, knee and hip flexion during the stance phase. This gait disorder is common among patients with cerebral palsy. The present article brings an up-to-date literature review on the pathoanatomy, natural history, and treatment of this frequent gait abnormality.
  
  
  RESULTS
  Hamstrings are often not shortened in patients with crouch. Patella alta must be addressed if surgery is performed. Surgical correction of joint contractures and lever arm dysfunction can be effectively achieved through a single-event multilevel surgery.
  
  
  CONCLUSIONS
  Crouch gait is a common gait deviation, often seen among ambulatory diplegic and quadriplegic patients, once they reach the pubertal spurt, when weak muscles can no longer support a toe walking pattern because of rapidly increased weight. This form of gait is highly ineffective and might compromise walking ability over time. The anterior knee is overloaded; pain, extensor mechanism failure, and arthritis might develop. Its progressive nature often requires surgical intervention. The cause of crouch gait is multifactorial, and surgery should be tailored to meet the individual's specific anatomic and physiologic abnormalities.
authors.affiliation: Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York, USA.
authors.forename: Paz
authors.initials: P
authors.lastname: Kedem
authors.forename: David M
authors.initials: DM
authors.lastname: Scher
mesh_terms: D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D018450:Disease Progression; D005684:Gait / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans