Natural History of Foot Deformities in Children with Cerebral Palsy

Abstract

Foot deformities in children with cerebral palsy may result from the interaction of many factors, including muscle spasticity and imbalance, soft-tissue contractures, bony torsion, and joint instability, all of which occur, for the very young child, within a dynamic context of neurologic maturation and longitudinal growth. Such a complicated scenario makes it difficult to describe the natural history of foot deformity in children with CP. In order to determine the most effective treatment paradigms and critically evaluate their outcomes, such knowledge is essential. Gait maturation in typically developing children occurs from the onset of walking through age 7 years, during which time, the movement, forces, muscle activity, and temporal parameters of gait evolve through predictable patterns of change. The natural history of gait maturation of children with CP does not follow these typical patterns, especially as related to timing. The young child with CP who starts to walk usually has planovalgus feet and equinus. The natural evolution of this deformity is for the foot to improve with less planovalgus and improved heel contact as the child goes through early childhood. Children with better neurologic function, meaning they are able to walk independently, will have a higher degree of improvement in the foot position towards normal and will continue to improve later, up to age 7 years. Some children at age 2 may have very severe planovalgus deformities that will have completely corrected by age 7 years and even on occasion will over correct into equinovarus. This means that there should seldom be surgery to correct planovalgus foot deformities prior to age 7 and only then for the most severe deformities. It is important to allow the foot to make its maximum natural correction by utilizing therapy and orthotics on a part-time basis. Data to support this approach are presented in this chapter.