Article

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.
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Langue : ANGLAIS