Gait analysis before and after gastrocnemius fascia lengthening in children with cerebral palsy.

Abstract

Equinus deformity is a common problem in children with spastic cerebral palsy (CP). Persistent deformity that interferes with function is treated by surgically lengthening the triceps surae. Surgical approaches carry a recurrence risk of equinus deformity or over correction with the development of calcaneal deformity, crouch and diminished strength for push-off during gait. These aspects interfere with the basic function of the gastrocnemius/soleus complex. This study aimed to analyze kinematic and kinetic effects of gastrocnemius fascia lengthening on gait pattern in children with CP and, in particular, the evaluation of push-off ability before and after treatment. Twenty children with CP were evaluated by clinical examination and three-dimensional gait analysis (GA) before and after (12 months) gastrocnemius fascia lengthening surgery (modified Vulpius' technique) to improve equinus foot and walking. The results showed a significant reduction in equinus foot, represented by a re-duction in the â angle (the angle between the foot and the ground on the sagittal plane) at initial contact (IC), closer to healthy children, and increased ankle power generation during push-off. Even if this result was not of a statistically significant level, it is important because it means that the surgery did not produce a functional weakness. Kinetic results showed an improvement (ankle joint power absorbed and generated) related to a more functional walking behavior. Some improvements concerning the knee joint are significant, in particular, the value of the knee angle at IC and of peak during the swing phase.