Indications for orthoses to improve gait in children with cerebral palsy

Orthoses are frequently used to improve the gait of children with cerebral palsy. Optimal clinical decision-making for improving gait through orthotic management requires an understanding of the biomechanics of the foot and ankle during normal gait, the pathophysiology and pathomechanics of gait disruption in children with cerebral palsy, and the biomechanical characteristics of various orthoses. The clinician must seek to integrate his or her own goals with those of the child and family, the therapist, and the orthotist. Design, indications, and cost should be considered when choosing an orthosis. The physician can construct a paradigm for clinical decision-making, focusing on the evaluation of ankle/foot alignment, range of motion, and assessment of dynamic gait deviations. This paradigm will guide the clinician in the use of orthoses to improve gait in children with cerebral palsy. For optimal orthotic management, the physician must clearly identify the gait deviation and functional deficits to be addressed with the orthosis. The outcome of the orthotic intervention should be documented as objectively as possible.