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Updated: Nov 19, 2025
Clinical-oriented Three-dimensional Gait Analysis Method for Evaluating Gait Disorder
Published on: March 4, 2018
Three-Dimensional Gait Analysis in Children Undergoing Gastrocsoleus Lengthening for Equinus Secondary to Cerebral
Norine Ma1, Nicholas Sclavos1, Elyse Passmore1,2,3
1Australia and Hugh Williamson Gait Laboratory, Pediatric Orthopedic Department, The Royal Children's Hospital, Parkville, Melbourne, VIC 3052, Australia.
Insights
Surgical lengthening of the gastrocsoleus muscle-tendon unit in children with cerebral palsy (CP) shows improved gait, but study quality is poor. More rigorous research is needed for better treatment recommendations.
Area of Science:
- Orthopaedic surgery
- Pediatric neurology
- Biomechanics
Background:
- Equinus deformity is the most common in children with cerebral palsy (CP).
- Gastrocsoleus muscle-tendon unit lengthening is the primary surgical intervention for CP equinus.
- Objective outcome measurement via three-dimensional gait analysis is crucial for evaluating surgical efficacy.
Purpose of the Study:
- To assess the evidence quality for gastrocsoleus lengthening surgery in CP using objective gait analysis.
- To synthesize findings on the effectiveness of this surgery based on current literature.
Main Methods:
- Systematic literature search of Medline, Embase, and PubMed (1990-2020).
- Inclusion criteria: studies on gastrocsoleus lengthening surgery in CP utilizing 3D gait analysis.
- Analysis of 34 selected studies.
Main Results:
- All 14 studies reporting swing phase kinematics demonstrated significant improvements.
- Recurrence rates of equinus and calcaneus varied widely across studies.
- Inconsistent follow-up periods and surgical techniques complicated direct comparisons.
Conclusions:
- The current evidence base for gastrocsoleus lengthening surgery in CP is limited by poor study quality and heterogeneity.
- Variability in patient populations (CP subtypes) and surgical approaches hinders definitive treatment recommendations.
- Future research should prioritize prospective designs, control groups, and detailed outcome stratification.
Abstract:
Background and Objectives: Equinus is the most common deformity in children with cerebral palsy, and surgical lengthening of the gastrocsoleus muscle-tendon unit is the most commonly performed operation for children with cerebral palsy. Treatment outcomes of orthopaedic surgery can be measured objectively with three-dimensional gait analysis. This study examined the quality of evidence for gastrocsoleus lengthening surgery based on objective measures. Materials and Methods: A search was performed with Medline, Embase and PubMed from 1990 to 25 August 2020 using the keywords "cerebral palsy", "equinus", "surgery" and "gait analysis". Only studies of gastrocsoleus lengthening surgery using three-dimensional gait analysis were included, yielding 34 studies. Results: Fourteen studies reported swing phase kinematics and all studies reported a significant improvement. Rates of recurrent equinus and calcaneus were reported in 21 studies and varied widely based on follow-up period and surgical technique. Conclusions: Poor study quality and marked variability in study samples and interventions made comparison difficult. Future studies should consider prospective design, controls or comparison groups and more detailed breakdowns of outcomes by cerebral palsy subtype, sagittal gait pattern, and equinus type in order to allow more rigorous treatment recommendations to be made.
