Ankle Equinus in Cerebral Palsy

Abstract

Ankle equinus is the most recognized symptom of cerebral palsy (CP). Ankle equinus was the first recognized symptom of CP for which a treatment was reported. It still continues to be one of the most common symptoms to attract the attention of many different specialists. Equinus, which is a primary cause of toe walking, is readily observed by family, friends, and neighbors, as well as all medical practitioners who might watch a child walk. Since it is such a visible aspect of CP, it also attracts the attention of many people who develop the concept that equinus and CP are different names for the same problem. There are multiple causes for equinus in the child with CP, which include poor motor control, spasticity, contractures of muscles, and ankle joint contracture. In some children the equinus is a compensatory position for problems in other parts of their musculoskeletal system. Since there are many causes of equinus there are also many treatment options. The best treatment options can be developed after appropriate diagnostic investigations. For ambulatory children, this often requires a full gait analysis evaluation to ascertain all of the causes of toe walking. When spastic plantar flexors cause equinus, there are many treatment options. These include botulinum toxin injection, therapy, casting, surgery, and various other neurologic interventions. Planning the best treatment options for spastic equinus requires understanding the natural history and considering the age of the child and the child’s overall condition. Treating toe walking and equinus in CP has a long history with many treatments coming into and going out of favor. Understanding this history can give some perspective on current treatment options.