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Crouch gait changes after planovalgus foot deformity correction in ambulatory children with cerebral palsy
Muayad Kadhim1, Freeman Miller1
1Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Insights
Surgical correction of planovalgus foot deformity in children with cerebral palsy (CP) can improve knee extension during gait. This study found that milder deformities and better preoperative ankle function led to greater gains in knee extension after foot surgery.
Area of Science:
- Orthopedics
- Pediatric Gait Analysis
- Cerebral Palsy Research
Background:
- Cerebral palsy (CP) often causes crouch gait due to spasticity and foot deformities.
- Planovalgus foot deformity, involving heel equinus and midfoot break, contributes to knee flexion during gait.
- Lever arm dysfunction in the foot can exacerbate crouch gait in ambulatory children with CP.
Purpose of the Study:
- To evaluate gait pattern changes after single-level planovalgus foot correction surgery in children with CP.
- To investigate the correlation between changes in knee flexion during stance and other kinematic/kinetic parameters post-foot surgery.
- To determine factors influencing improved knee extension after surgical correction of planovalgus foot deformity.
Main Methods:
- Retrospective cohort study of 21 children (34 feet) with CP undergoing planovalgus foot correction.
- Exclusion of patients with concurrent knee, hip, or pelvis surgeries.
- Analysis of gait parameters, focusing on maximum knee extension at stance (MKE-dif) before and after surgery, including subtalar fusion or lateral calcaneal lengthening.
Main Results:
- Increased maximum knee extension at stance (MKE-dif) was observed post-surgery, indicating reduced crouch gait.
- Greater improvement in MKE was associated with milder preoperative planovalgus deformity and higher preoperative ankle dorsiflexion and power.
- Postoperative knee extension gains correlated with corrected ankle hyperdorsiflexion and increased knee extension at initial contact and knee power.
Conclusions:
- Surgical correction of planovalgus foot deformity can improve knee extension in ambulatory children with CP.
- Patients with significant preoperative ankle dorsiflexion may benefit from foot surgery to reduce ankle dorsiflexion without necessitating knee surgery.
- Foot deformity correction offers a potential strategy to mitigate crouch gait by addressing underlying biomechanical issues in the lower limb.
Abstract:
Ambulatory children with cerebral palsy (CP) may present with several gait patterns due to muscular spasticity, commonly with crouch gait. Several factors may contribute to continuous knee flexion during gait, including hamstring and gastrocnemius contracture. In planovalgus foot deformity, the combination of heel equinus, talonavicular joint dislocation, midfoot break and external tibial torsion also contribute to crouch gait as part of lever arm dysfunction. In this retrospective cohort study, we assessed 21 children with CP (34 feet) who underwent planovalgus foot correction as a single level surgery. Fifteen feet underwent subtalar fusion and 19 feet had lateral calcaneal lengthening. Patients who underwent knee, hip or pelvis surgeries were excluded from the study. The aim was to examine the changes in gait pattern and the correlation between the changes of knee flexion at stance phase with the other kinematic and kinetic parameters after foot surgery. Post surgery change of Maximum knee extension at stance (MKE-dif) was the outcome of interest. The magnitude of change in MKE after surgery increased (less crouch after surgery) in patients who had milder preoperative planovalgus feet and higher preoperative ankle maximum dorsiflexion at stance and ankle power. The gain of knee extension after surgery correlated with correction of ankle hyperdorsiflexion and with increase of knee extension at initial contact and knee power. Patients with high preoperative ankle maximum dorsiflexion may benefit from surgical foot deformity correction to achieve decreased ankle dorsiflexion with no knee surgical intervention.
