The difficulty identifying intoeing gait in cerebral palsy

In-toeing in children with cerebral palsy can lead to functional difficulties during gait. This may require surgical management to restore a normal foot progression angle. For this reason it is important to indentify the presence of internal rotation and to establish where the abnormal rotation is occurring. This can be done relatively easily in otherwise healthy subjects by examining foot progression angle as the subject walks towards the assessor. In cerebral palsy the often severely affected gait pattern and potential asymmetry at the pelvis means that in-toeing may be more difficult to identify. Gait laboratory data of 245 subjects with cerebral palsy were studied retrospectively. Of these 102 (41.63%) demonstrated in-toeing relative to the pelvis of one or both limbs. Eleven diplegic subjects (16.18%) in-toed bilaterally giving a total of 113 in-toeing limbs for analysis. Of those, 17 (50%) hemiplegic limbs and 20 (25.32%) diplegic limbs demonstrated a foot progression angle within normal limits due to compensations at the pelvis.