[Treatment of pediatric spastic foot deformities]

The pathophysiology of gait under the influence of cerebral-spastic leg musculature and the resulting biomechanical effects are demonstrated. The latter must be taken into account for successful treatment of functional disturbances and in the shape of the feet in children with cerebral-spastic disturbances in movement. Co-contractions in antagonistic muscle groups of the lower extremities during the second half of the stance phase, the propulsion period of the step, are the main obstacles to achieving efficient gait. The causes lie in the spastic increase of the muscle stretch reflex as well as in a defect in the reciprocal inhibition of antagonistic muscle groups. Moderate equinus gait and an increase in the normal differences in the development of force by the dorsal and plantar flexing muscles represent effective physiological compensation for these disturbances. The common secondary changes in the shape of the foot resulting from spasticity and contractures of the muscles require long-term planning of treatment, including physiotherapy, plaster casts, plastic orthoses, orthopedic shoes and, in some cases, operations, which should be delayed as long as possible during the growth phase. Premature lengthening of the Achilles tendon regularly results in iatrogenic foot deformities.