Cerebral palsy

Cerebral palsy is the result of an injury to the brain. This injury is fixed and non-progressive and results in motor impairment (difficulty in controlling movement). Damage to the brain may occur antenatally, at birth or during childhood. The clinical manifestations of cerebral palsy depend on which part and how much of the brain are involved. Individual cases vary from intellectually normal children who walk on their toes to non-communicative wheelchair bound children with seizures.

Many patients have ‘equinus’. This is defined as increased plantar flexion secondary to a plantar flexion contracture or dynamic plantar flexion secondary to over-activity of the gastrocsoleus during gait. Such patients walk on their toes but also have muscle spasticity and abnormal reflexes. Their ankle problems may induce hyperextension of the knees. Treatment options include botulinum toxin (Botox) injections, casting and operations such as gastrocnemius recession or Achilles tendon lengthening.

An ‘equinovarus’ deformity is similar to ‘equinus’ but also has in-turning of the foot. This is due to muscular imbalance, where the posterior and anterior tibialis muscles (invertors) overpower the peroneal muscles (evertors). Patients complain of pain and calluses from walking on the lateral border of the foot. Treatment options include bracing, Botox, tendon lengthening and transfers, osteotomies and fusions.

A ‘pes valgus’ deformity is another possible foot deformity in cerebral palsy. This is a tight spastic flat foot. Conservative treatment is very important, comprising orthotic insoles and custom-made shoes. Soft tissue procedures are often inadequate in such cases. Bony surgery includes: The Grice extra-articular arthrodesis; lateral column lengthening; calcaneal osteotomy and triple arthrodesis.