Prevalence of Crouch Gait and Its Association with Altered Walking Kinematics in Children with Spastic Cerebral Palsy

Abstract

Background: Crouch gait is a stance-phase pattern of excessive knee flexion with limited hip extension and increased ankle dorsiflexion which impairs walking efficiency and accelerates musculoskeletal morbidity in spastic cerebral palsy (CP), yet contemporary prevalence estimates and kinematic correlates from resource-limited clinics remain sparse. Objective: To quantify the prevalence of crouch gait in ambulant children with spastic CP and determine its associations with sagittal kinematics, spatiotemporal parameters, tone, and selective motor control using a pragmatic 2D video workflow. Methods: In a cross-sectional study, 113 children (6–14 years; mean age 10.28) with GMFCS I–III underwent standardized sagittal plane recording and analysis in Kinovea. Primary measures were hip, knee, and ankle angles during stance; step length, stride length, and cadence; GMFM-88 (D,E); SCALE; MAS; and passive ROM by goniometry. Associations were tested with χ². Results: Crouch gait prevalence was 87.6%. It was associated with CP subtype (diplegia predominant, p<0.001), side dominance (bilateral, p<0.001), lower GMFM-88 (p=0.043), impaired SCALE (p=0.037), and higher MAS (p<0.001). Significant ROM/kinematic correlates included reduced hip extension (p=0.002), greater knee flexion (p<0.001), reduced knee extension (p=0.004), and increased ankle dorsiflexion (p<0.001); ankle plantarflexion was not significant (p=0.867). Spatiotemporal indices were adverse: shorter steps and strides (both p<0.001) with cadence differences (p=0.001). Conclusion: Crouch gait is highly prevalent in ambulant spastic CP and tightly linked to a reproducible sagittal deviation profile and spatiotemporal inefficiency, supporting early identification and extensor/push-off–focused interventions feasible with 2D video analysis.