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Crouch gait changes after planovalgus foot deformity correction in ambulatory children with cerebral palsy.
Gait Posture. 2014 Feb; 39(2):793-8.GP

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.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA. Electronic address: fmiller@nemours.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24316233

Citation

Kadhim, Muayad, and Freeman Miller. "Crouch Gait Changes After Planovalgus Foot Deformity Correction in Ambulatory Children With Cerebral Palsy." Gait & Posture, vol. 39, no. 2, 2014, pp. 793-8.
Kadhim M, Miller F. Crouch gait changes after planovalgus foot deformity correction in ambulatory children with cerebral palsy. Gait Posture. 2014;39(2):793-8.
Kadhim, M., & Miller, F. (2014). Crouch gait changes after planovalgus foot deformity correction in ambulatory children with cerebral palsy. Gait & Posture, 39(2), 793-8. https://doi.org/10.1016/j.gaitpost.2013.10.020
Kadhim M, Miller F. Crouch Gait Changes After Planovalgus Foot Deformity Correction in Ambulatory Children With Cerebral Palsy. Gait Posture. 2014;39(2):793-8. PubMed PMID: 24316233.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Crouch gait changes after planovalgus foot deformity correction in ambulatory children with cerebral palsy. AU - Kadhim,Muayad, AU - Miller,Freeman, Y1 - 2013/11/02/ PY - 2013/03/26/received PY - 2013/10/21/revised PY - 2013/10/27/accepted PY - 2013/12/10/entrez PY - 2013/12/10/pubmed PY - 2014/10/15/medline KW - Calcaneal lengthening KW - Cerebral palsy KW - Crouch gait KW - Pes planovalgus KW - Subtalar fusion SP - 793 EP - 8 JF - Gait & posture JO - Gait Posture VL - 39 IS - 2 N2 - 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. SN - 1879-2219 UR - https://www.unboundmedicine.com/medline/citation/24316233/Crouch_gait_changes_after_planovalgus_foot_deformity_correction_in_ambulatory_children_with_cerebral_palsy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0966-6362(13)00654-1 DB - PRIME DP - Unbound Medicine ER -