Crouch Gait in Cerebral Palsy

Abstract

Children with cerebral palsy (CP) start to walk usually with an assistive device typically a walker. Children who start to walk independently by age 3 are usually more mild and at lower risk for late severe deformities which impair their gait. As children develop and mature in their gait pattern, they very frequently develop abnormal knee kinematic patterns especially increased knee flexion in stance phase. This is much more common in children with diplegia or bilateral CP compared to those compared with hemiplegia or unilateral involvement. A very common problem is increased knee flexion in stance phase which is typically called crouch gait. Crouch gait (flexed knee gait) is a very complex multidimensional deformity in children whose natural history is extremely variable. The primary focus of crouch gait tends to be knee flexion in stance phase; however, this syndrome often involves torsional malalignment of the femur or tibia, ankle positional problems either equinus or hyper-dorsiflexion, as well as foot postural problems typically planovalgus. Treatment of crouch gait requires very careful assessment with three-dimensional gait analysis and identification of all the pathologic features which require correction. Surgical correction is usually carried out with single-event multilevel surgery (SEMLS). This chapter defines the current understanding of the etiology of crouch gait, the correct full evaluation, and the surgical planning requirements.