The natural history of gait pattern change in children with spastic diplegia is a transition from toe walking to progressive hip and knee flexion with eventual crouch gait. This has been attributed to the adolescent growth spurt, progressive lever arm dysfunction, and iatrogenic weakening of the soleus with isolated tendo achilles lengthening (TAL). The relative contribution of TAL to the development of crouch gait is uncertain. The purpose of this study was to identify the frequency of crouch gait in spastic diplegic patients with and without history of prior TAL.

Patients with spastic diplegia greater than 10 years of age with instrumented gait analysis were reviewed. Exclusion criteria included diagnosis other than cerebral palsy, prior dorsal root rhizotomy, or incomplete past surgical history. Patients were divided into three groups: Group 1, no prior orthopaedic surgical intervention; Group 2, prior orthopaedic surgery without TAL; Group 3, prior orthopaedic surgery with TAL. Instrumented gait analysis data was analysed. Gait data were analysed using a single randomised limb from each patient.

One hundred and seventy-eight patients were identified: 39 in Group 1, 49 in Group 2, and 90 in Group 3. Mean time from TAL to gait analysis was 7.5 years (range 1.0–14.6 years). Mean age at TAL was 6.3 years (range 1.2–17.5 years). There was no significant difference in age, BMI, walking speed, or cadence between groups. Kinematic analysis showed no significant difference in mean stance phase maximum knee or ankle flexion between groups. There was no significant difference in frequency of increased mid stance knee flexion between groups (Group 1, 53.8%; Group 2 46.9%; Group 3, 43.3%, p=0.546). There was a trend towards increased frequency in excessive stance phase ankle dorsiflexion in Group 3 (60% Group 3 vs 46.2% Group 1, and 40% Group 2, p=0.071). Crouch gait (stance minimum hip flexion > 30, mid stance minimum knee flexion > 200, and stance maximum ankle dorsiflexion > 150) was seen with similar frequency in all groups (Group 1, 23.1%; Group 2, 18.4%; Group 3, 26.7%; p=0.544).

There is a trend towards increased frequency of excessive stance phase ankle dorsiflexion in spastic diplegic patients with prior TAL. However, no significant difference in frequency of crouch gait between patients with and without history of TAL was identified. Crouch gait is part of the natural history of gait pattern change in spastic diplegic patients independent of prior surgical intervention.

Purpose: Currently, clubfoot is initially treated with non-operative methods including Ponseti casting and the French physical therapy program (PT). Our purpose was to evaluate the function of children treated with these techniques.

Methods: Seventy-six idiopathic clubfoot patients were enrolled. Successful non-operative outcomes were achieved in 32 patients (44 feet) treated with casting and 44 patients (66 feet) treated by PT. Initial Dimeglio scores were 10–17. At average age 2.3 years (1.9–3.3yr), subjects’ gait was evaluated with a VICON 512 motion analysis system. Cadence and kinematic data was classified as abnormal if it fell outside of one standard deviation from normal.

Results: No statistical differences for cadence parameters were found between the two groups. Two kinematic patterns were identified: Children treated with PT walked with knee hyperextension (41% of feet)*, equinus (17%)*, and foot-drop (28%)*; whereas zero casted patients walked in equinus and only one demonstrated foot-drop. In contrast, the casted group demonstrated increased stance dorsiflexion (47%)* and calcaneus (18%). More PT feet had increased internal foot progression angle (34% vs. 13%)* and increased shank-based foot rotation (56% vs. 33%)*. Both groups had equal rates of normal sagittal-plane ankle motion (59% PT vs. 55%). [*p< 0.05].

Conclusions: Half of the two year-old patients treated non-operatively for clubfoot had normal sagittal-plane ankle motion. Less than 20% in each group experienced calcaneus and equinus gaits, respectively. These differences may be the result of performing percutaneous tendo Achilles lengthening as part of the Ponseti casting technique, but not as part of the PT program.

Introduction and Aims: While scoliosis is known to be associated with Charcot-Marie-Tooth disease, little is known about the response to treatment of spinal deformity in this population. The purpose of this study was to characterise scoliosis in CMT, and to assess the effect of bracing and the efficacy and safety of surgery.

Method: A retrospective review of medical records and radiographs of patients with CMT from a major neuro-muscular clinic was performed to calculate the prevalence of scoliosis and to characterise the deformity in affected patients. Orthotic and operative records were reviewed in patients who were braced and/or had spinal fusions.

Results: Forty-three of 271 patients with CMT had scoliosis, for a prevalence of 15.9%. There were 18 females and 25 males, and the age at diagnosis of scoliosis averaged 12.7 years (range 7.8–17.8 years). Thirty-one of 43 curves were in the thoracic spine, with 15 curves being left thoracic. Curve magnitude at diagnosis averaged 27.8 degrees (11–65 degrees), and 18 of 34 curves with available lateral radiographs had hyperkyphosis.

Curve progression of more than five degrees was present in 67.9% of those curves with follow-up. All five non-ambulatory patients progressed and had surgery. Bracing was prescribed in 39.5% of patients, and 11 of 15 braced patients progressed and had surgery.

Surgery was scheduled in 32.6% of patients. The average age at surgery was 13.8 years (11.5–15.8 years), and curve magnitude averaged 63.1 degrees (50–80 degrees), with 78.6% of surgical curves being kyphotic. Posterior spinal fusion was performed in 11, anterior/posterior fusion in one, and halo traction followed by posterior spinal fusion in one. All curves were instrumented. Curve correction averaged 51.7%. Intra-operative neurologic monitoring (SSEP’s +/− MEP’s) was successful in only three of 11 patients. No neurologic complications occurred. One re-operation for delayed infection was necessary.

Conclusion: Scoliosis occurs in 15.9% of CMT patients. It is associated with thoracic kyphosis and an increased incidence of left thoracic curves. Bracing is usually unsuccessful. Surgery was necessary in 32.6% overall, and 100% of non-ambulators who had scoliosis. Instrumentation was safe and effective, but intra-operative neurologic monitoring is usually impossible.