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Causes of intoeing gait in children with cerebral palsy
Susan A Rethlefsen1, Bitte S Healy, Tishya A L Wren
1Childrens Orthopaedic Center, Childrens Hospital Los Angeles, 4650 Sunset Boulevard, M/S 69, Los Angeles, CA 90027, USA. srethlefsen@chla.usc.edu
Insights
Intoeing in children with cerebral palsy often has multiple causes, primarily internal hip rotation and tibial torsion. Pes varus is a common cause in hemiplegia but rare in diplegia/quadriplegia.
Area of Science:
- Pediatric Orthopedics
- Gait Analysis
- Cerebral Palsy Research
Background:
- Intoeing is a common gait abnormality in children diagnosed with cerebral palsy.
- Accurate identification of intoeing causes is crucial for effective surgical planning.
Purpose of the Study:
- To determine the prevalence of different causes of intoeing in children with cerebral palsy.
- To investigate if causes of intoeing vary between bilateral (diplegia/quadriplegia) and unilateral (hemiplegia) cerebral palsy.
Main Methods:
- Retrospective analysis of gait in 412 children with cerebral palsy (587 involved sides).
- Causes of intoeing were assessed using gait analysis.
- Evaluation was conducted separately for bilateral and unilateral cerebral palsy cases.
Main Results:
- The most frequent causes of intoeing were internal hip rotation (55%) and internal tibial torsion (50%).
- Multiple etiologies for intoeing were observed in over one-third (37%) of involved limbs.
- Pes varus was a significant contributor in hemiplegic (43%) but not in bilateral (8%) cerebral palsy.
Conclusions:
- Over one-third of children with cerebral palsy exhibit multiple contributing factors to their intoeing gait.
- Pes varus is a key factor in hemiplegic intoeing, contrasting with its rarity in diplegic/quadriplegic presentations.
- Understanding these specific etiological differences is vital for guiding surgical interventions in pediatric cerebral palsy patients.
Background:
Intoeing is a frequent gait problem in children with cerebral palsy. It is essential to determine the cause(s) of intoeing when surgical intervention is being planned. The purpose of this study was to evaluate the prevalence of various causes of intoeing in children with cerebral palsy and to determine whether the causes differ between children with bilateral and those with unilateral involvement.
Methods:
The cause of intoeing gait was examined retrospectively, with use of gait analysis, in 412 children with cerebral palsy (587 involved sides). The causes were evaluated separately for the children with bilateral involvement (diplegia or quadriplegia) and those with hemiplegia.
Results:
Overall, the most common causes of intoeing were internal hip rotation (322 of 587 sides) and internal tibial torsion (296 of 587 sides). Pes varus contributed to intoeing of thirty-five of the eighty-two involved limbs of the patients with hemiplegia and of forty-two of the 505 limbs of the patients with diplegia or quadriplegia. Multiple causes of intoeing were noted in 215 of the 587 involved limbs, including 176 of the 505 limbs of the patients with bilateral involvement and thirty-nine of the eighty-two involved limbs of the patients with hemiplegia. The most common causes of intoeing in the subjects with bilateral involvement were internal hip rotation (288 of 505), internal tibial torsion (261 of 505), and internal pelvic rotation (ninety-two of 505). The most common causes in the hemiplegic children were internal tibial torsion (thirty-five of eighty-two), pes varus (thirty-five of eighty-two), internal hip rotation (thirty-four of eighty-two), and metatarsus adductus (twenty of eighty-two).
Conclusions:
More than one-third of children with cerebral palsy have multiple causes of intoeing. Pes varus commonly contributes to intoeing by children with hemiplegic cerebral palsy but rarely contributes to intoeing by those with diplegia or quadriplegia. These findings should be carefully considered prior to surgical correction of the intoeing gait of these patients.
