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Updated: Oct 21, 2025
Clinical-oriented Three-dimensional Gait Analysis Method for Evaluating Gait Disorder
Published on: March 4, 2018
The change in sagittal plane gait patterns from childhood to maturity in bilateral cerebral palsy
Bidzina Kanashvili1, Freeman Miller1, Chris Church1
1Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE 19803, United States.
Insights
Gait patterns in children with cerebral palsy (CP) tend to develop into crouch gait with improved ankle motion. Surgery to lengthen calf muscles did not significantly alter knee flexion progression in these patients.
Area of Science:
- Orthopedics
- Pediatric Gait Analysis
- Cerebral Palsy Research
Background:
- Longitudinal stability of sagittal gait patterns in diplegic cerebral palsy (CP) is not well understood.
- Stratification using the Rodda classification provides a framework for analyzing gait deformities.
Purpose of the Study:
- To investigate the trajectory of sagittal plane gait deformities in a large cohort of children with CP.
- To analyze changes in gait patterns from childhood to maturity, considering orthopedic surgery guided by gait analysis.
Main Methods:
- Retrospective study using gait analysis data from before age 8 and after age 15.
- Gait parameters were evaluated, and limbs were classified using the Rodda classification.
- Statistical analysis (Welch's t-tests) compared gait variables over time and assessed the impact of plantarflexor lengthening surgery.
Main Results:
- 100 youth with CP were evaluated, showing a shift towards crouch gait (52.5%) at maturity.
- Ankle dorsiflexion in stance significantly increased from childhood to maturity (p < 0.001).
- Plantarflexor lengthening surgery did not significantly affect stance phase knee flexion at maturity.
Conclusions:
- Gait in children with CP tends to progress towards crouch with improved ankle dorsiflexion.
- Surgical interventions like plantarflexor lengthening may not alter the progression of knee flexion in the sagittal plane.
Background:
The longitudinal stability of sagittal gait patterns in diplegic cerebral palsy (CP), stratified using the Rodda classification, is currently unknown.
Research Question:
What is the trajectory of sagittal plane gait deformities as defined by the Rodda classification in a large cohort treated with orthopedic surgery guided by gait analysis?
Methods:
A retrospective study utilized gait analysis to evaluate sagittal gait parameters before age 8 and after age 15 years. Individual limbs were categorized at each time point according to the Rodda classification based on mean sagittal plane knee and ankle angle during stance. Welch's t-tests compared gait variables from early childhood with maturity and examined changes associated with plantarflexor lengthening surgery.
Results:
100 youth with CP were evaluated twice: at a mean age of 5.49 ± 1.18 and 19.09 ± 4.32 years, respectively. Gross Motor Function Classification System distribution at maturity was I (10.5 %), II (55.2 %), III (28.6 %), and IV (5.7 %). At the initial visit, most limbs were in either true equinus (30 %) or jump-knee gait (26.5 %). At maturity, crouch gait (52.5 %) was the most common classification, of which 47.6 % were mild (1-3 standard deviations from age-matched norm; 21°-30°) and 52.4 % moderate or severe. For the entire cohort, at initial and final visits, respectively, mean knee flexion in stance was 26.8°±14.8° and 25.9°±11.4° (p = 0.320), ankle dorsiflexion in stance increased from -0.3°±11.5° to 9.0°±6.0° (p < 0.001), and passive knee flexion contracture was -2.3°±7.0° and -3.9°±8.0° (p = 0.043). In children who started in true equinus, apparent equinus, and crouch, there was no difference in stance phase knee flexion at maturity between those who underwent plantarflexor lengthenings versus those who did not (p > 0.18).
Significance:
The trend in this cohort was toward crouch with increased stance phase ankle dorsiflexion from early childhood to maturity. Plantarflexor lengthenings were not a significant factor in the progression of stance phase knee flexion.
