Evaluation and management of crouch gait

Area of Science:

• Orthopedics
• Neurology
• Biomechanical Engineering

Background:

• Crouch gait, characterized by excessive ankle dorsiflexion and knee/hip flexion during stance, is prevalent in cerebral palsy (CP).
• This gait disorder often emerges during the pubertal spurt due to increased body weight overwhelming weakened muscles, leading to a toe-walking pattern.
• It is a progressive condition that compromises walking ability, increases anterior knee load, and can lead to pain, extensor mechanism failure, and arthritis.

Purpose of the Study:

• To provide an up-to-date literature review on the pathoanatomy, natural history, and treatment of crouch gait.
• To highlight the multifactorial causes of crouch gait and the importance of individualized surgical approaches.

Main Methods:

• Literature review of existing studies on crouch gait in cerebral palsy.
• Analysis of pathoanatomic features, natural progression, and current treatment strategies.

Main Results:

• Hamstring length is not consistently a factor in crouch gait.
• Patella alta is a significant consideration in surgical planning.
• Single-event multilevel surgery can effectively address joint contractures and lever arm dysfunction.

Conclusions:

• Crouch gait is a common, progressive, and ineffective gait deviation in ambulatory CP patients, often requiring surgical intervention.
• The underlying causes are multifactorial, necessitating personalized surgical strategies.
• Surgical correction aims to improve gait mechanics and prevent long-term complications like knee pain and arthritis.