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Gradual serial extension weight bearing casting protocol improves knee range of motion and sagittal plane kinematics in children with cerebral palsy, crouch gait and knee flexion contractures
Author(s) -
V SCHREIBER,
L COBB,
J LONG,
J MCCARTHY
Publication year - 2017
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.81_13511
Subject(s) - cerebral palsy , sagittal plane , range of motion , muscle contracture , physical medicine and rehabilitation , medicine , kinematics , gait , weight bearing , knee flexion , physical therapy , orthodontics , anatomy , surgery , physics , classical mechanics
months (range 9 to 67mo). Materials/Methods: Foot progression angle data collected from the preand postoperative gait analyses were compared to a normal value of 8° (externally rotated). The normal value was determined from age-specific data collected through the gait laboratory. The FPA, as defined by markers on the posterior calcaneus and the second metatarsal, was measured at 2% intervals of the gait cycles over a 100-meter walkway. This data was averaged to a single value which is referred to as FPA. The mean difference in FPA was determined by comparing the absolute difference of the postoperative FPA from normal to the preoperative FPA from normal. Results: The mean difference in FPA from preoperative to postoperative analyses was 2.4 (95% CI: 2.9, 7.8) and not significantly different from 0; p=0.36. Nine feet showed FPA improvement and 15 showed FPA deviation from normal. In 14 feet, the postoperative FPA was more internal, whereas in 10 feet, the postoperative FPA was more external relative to preoperative FPA. Conclusions/Significance: The clinical improvement of symptomatic pes planovalgus deformity remains a known benefit of calcaneal lengthening osteotomy; however, FPA should not be an indicator for surgical treatment. Additionally, calcaneal lengthening osteotomy more often led to a deviation from normal FPA in 63% of cases. This procedure does not appear to result in exclusive internal rotation of FPA, which would be expected. Possible explanations for these results include unforeseen impacts of concurrent procedures and neuromuscular changes including worsening joint contractures, muscle tone, and deformities during the time between gait analyses. Limitations of this study include variable time between gait analyses and surgery and length of time between gait analyses.