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Severe crouch gait in spastic diplegia can be prevented: a population-based study
C Vuillermin1, J Rodda, E Rutz
1The Royal Children's Hospital, Orthopaedic Department, Flemington Road, Parkville, Victoria 3052, Australia.
Insights
Changes in managing equinus gait significantly reduced severe crouch gait in children with spastic diplegia. Isolated gastrocsoleus lengthening was linked to this condition, highlighting the importance of surgical technique monitoring.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Neurology
Background:
- Severe crouch gait is a common complication in children with spastic diplegia.
- Previous management of equinus gait involved observational methods and isolated gastrocsoleus lengthening.
- The impact of updated surgical protocols on severe crouch gait prevalence was unknown.
Purpose of the Study:
- To investigate the prevalence of severe crouch gait in children with spastic diplegia (GMFCS levels II-III) over 15 years.
- To assess the effect of changes in equinus gait management on severe crouch gait incidence.
- To identify potential contributing factors to severe crouch gait.
Main Methods:
- Retrospective study of 464 children with spastic diplegia undergoing 3D gait analysis.
- Comparison of severe crouch gait prevalence before and after protocol changes.
- Analysis of surgical interventions, specifically gastrocsoleus lengthening versus gastrocnemius recession.
Main Results:
- The prevalence of severe crouch gait decreased significantly from 25% to a stable rate of 0-4% annually after protocol changes (p < 0.001).
- Isolated lengthening of the gastrocsoleus was associated with the development of severe crouch gait.
- Three-dimensional gait analysis and multilevel surgery replaced older methods.
Conclusions:
- Isolated gastrocsoleus lengthening precipitates severe crouch gait in pediatric spastic diplegia.
- Updated surgical management strategies, including gastrocnemius recession and 3D gait analysis, effectively reduce severe crouch gait.
- Severe crouch gait can serve as a valuable indicator for surgical management quality in pediatric cerebral palsy.
Abstract:
We studied the prevalence of severe crouch gait over a 15-year period in a defined population of children with spastic diplegia and Gross Motor Function Classification System levels II and III, to determine if there had been a decrease following changes to the management of equinus gait. These changes were replacing observational with three-dimensional gait analysis, replacing single level with multilevel surgery, and replacing gastrocsoleus lengthening with gastrocnemius recession. Of 464 children and adolescents with spastic diplegia who underwent three-dimensional gait analysis, 27 had severe crouch gait. Seventeen of these had been managed by isolated lengthening of the gastrocsoleus. Following changes in the management of equinus gait, the prevalence of severe crouch gait decreased from 25% and stabilised at a significantly lower rate, fluctuating between 0% and 4% annually (p < 0.001). We conclude that severe crouch gait in this population was precipitated by isolated lengthening of the gastrocsoleus. These findings may be relevant to other surgical populations, as severe crouch gait may be a useful way to monitor the quality of the surgical management of abnormal gait in children with cerebral palsy and spastic diplegia.
