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Examination of a Child with Cerebral Palsy
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
It is important to have knowledge of normal dorsiflexion possible in a child. It is around 20–25° of dorsiflexion at 3 years of age, which diminishes to 10° by 15 years of age. Equinus can be either due to contracture of the gastrocsoleus, which is fixed plantarflexion deformity or may be dynamic due to overactivity of the gastrocsoleus during gait where the foot can be brought to neutral position or even dorsiflexion on persistent, passive, gentle stretch. The examiner should keep in mind other etiologies of toe-walking like idiopathic toe-walking with isolated congenital short Achilles tendon, muscular dystrophies, spina bifida, arthrogryposis, etc. Children with muscular dystrophy may have a history of delayed walking and/or positive Gower’s sign apart from abnormal laboratory values of creatinine phosphokinase.
Orthopaedics and Fractures
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Spontaneous improvement is likely but in some families there is a history of idiopathic toe-walking and these cases may require further treatment with physiotherapy or release of the Achilles tendon if this is tight.
Neurological disorders
Published in Michael Horvat, Ronald V. Croce, Caterina Pesce, Ashley Fallaize, Developmental and Adapted Physical Education, 2019
Michael Horvat, Ronald V. Croce, Caterina Pesce, Ashley Fallaize
The persistence of undesirable reflexes and some developmental delay are characteristic of all types of cerebral palsy. For teachers it is important to understand the influence of these reflexes on normal motor development, muscle tone, and postures. For example, persistence of the TLR will interfere with postural control and mechanics, such as balance and tone needed for unsupported sitting or standing. The persistence of this reflex will not only disturb muscle tone and equilibrium in unsupported movements but also interfere with initiating purposeful movement. Many normal postural reactions may be totally lacking or incomplete. Movements that require constant changes in tone and equilibrium are then disrupted with the persistence of this primitive reflex. In addition, scissoring may occur because of the adduction and internal rotation of the hips. Toe walking may occur because of the tendency of a shortened gastrocnemius to lift the heel from the ground. Intervention should be aimed at inhibiting primitive reflexes and initiating purposeful and functional movements. It is important to enhance and sustain physical activity interventions to maintain function and avoid deterioration in performance (Bar-Or & Rowland, 2004).
Analysis of foot kinematics during toe walking in able-bodied individuals using the Oxford Foot Model
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Wonhee Lee, Beomki Yoo, Dongho Park, Juntaek Hong, Dain Shim, Joongon Choi, Dong-wook Rha
Heel-toe walking (HW) is the standard gait, with the heel-strike as the initial contact in the stance phase. During HW, progression over the supporting limb is assisted by the functional rockers: the heel rocker, the ankle rocker, and the forefoot rocker (Perry et al. 1992). Toe walking, in contrast, is a gait that involves walking on the toes without a heel-strike during the stance phase, which cannot be assisted by functional rockers. The foot kinematics that are changed during toe walking include movements of the subtalar joint, transverse tarsal joint, and metatarsophalangeal joint (Hsu et al. 2008). In addition, there are differences not only in the ankle joint, but also in the hip and knee joints, compared to HW (Hampton et al. 2003; Alvarez et al. 2007; Armand et al. 2007; Romkes and Brunner 2007). The biomechanical difference between toe walking and HW in able-bodied individuals has been previously analyzed to investigate the etiology of toe walking (Kerrigan et al. 2000; Perry et al. 2003; Sasaki et al. 2008). Bovi et al. (2011) analyzed toe walking in able-bodied individuals and obtained kinematic data of the hip, knee, and ankle joints using the Lamb marker set. However, study of toe walking in able-bodied individuals to evaluate foot kinematics has been limited. To analyze foot and ankle kinematics by motion capture during the gait cycle, the Oxford Foot Model (OFM) was used. The OFM is a multi-segmented model that evaluates foot and ankle kinematics by measuring the motion between the forefoot, hindfoot, and toes via an optoelectrical method and motion analysis. The OFM is used to measure foot kinematics during normal walking and pathologic walking conditions resulting from various neurological and musculoskeletal disorders (Deschamps et al. 2010; Balzer et al. 2013; Grin et al. 2018, 2019).