Foot Deformities Impact on Cerebral Palsy Gait

Abstract

Based on our understanding of normal gait, we know the musculoskeletal subsystems function as a series of mechanical components linked by joints. Each of these segment components and the connecting joints has a specific role in gait. As the demands of an abnormal gait occur due to abnormalities in motor control, energy production, and balance problems, the mechanical aspects of the musculoskeletal system require adjustments to occur. There can be adaptive adjustments that accommodate for the problem at a different location, or the problem may be primary and the source of the problem requiring the adaptation elsewhere. Sorting out this impact is very important when planning treatment because secondary adaptations need no treatment, as they will resolve when the primary problem is addressed. The foot is an important element in this mechanical system because it makes contact with the floor and requires stability. The foot can be compromised by a primary deformity in the foot itself, such as planovalgus, equinovarus, or mid foot break. In these situations, the foot becomes flexible and is not a stable base upon which to support the body. Some of these deformities also cause abnormal rotation, causing the foot not line up with the knee axis, further making stability difficult. There may also be contractures that prevent the ankle from allowing the foot to dorsiflex which is a major cause of toe walking. This creates a difficult environment for the muscles to generate power for pushoff. The goal of this chapter is to further explain the impacts of these foot deformities on the gait of children with cerebral palsy.