Foot and ankle motion in cerebral palsy

Abstract

There are three common ankle/foot segmental malalignment patterns seen in children with cerebral palsy (CP): equinus, equinoplanovalgus, and equinocavovarus. Each type of ankle/foot malalignment can be classified into three levels based upon the presence of dynamic muscle imbalance, fixed or myostatic deformity of the muscle-tendon unit, and fixed or skeletal deformities. Management of foot and ankle deformities in children with CP can consist of both nonsurgical (orthotics and pharmacotherapy) and surgical (muscle-tendon unit lengthening or transfer, skeletal osteotomies or arthrodeses) modalities. The goals of these surgeries are to rebalance muscle activity, restore range of motion, and realign the skeletal segments of the foot. Clinical decision-making for the management of the ankle/foot in children with CP involves a diagnostic matrix utilizing data from the clinical history, physical examination, radiographic imaging, and quantitative gait analysis.