Article

Cerebral palsy (CP) is a complex syndrome, with multiple interactions between
joints and muscles. Abnormalities in movement patterns can be measured using
motion capture techniques, however determining which abnormalities are primary,
and which are secondary, is a difficult task. Deformity of the foot has
anecdotally been reported to produce compensatory abnormalities in more proximal
lower limb joints, as well as in the contralateral limb. However, the exact
nature of these compensations is unclear. The aim of this paper was to provide
clear and objective criteria for identifying compensatory mechanisms in children
with spastic hemiplegic CP, in order to improve the prediction of the outcome of
foot surgery, and to enhance treatment planning. Twelve children with CP were
assessed using conventional gait analysis along with the Oxford Foot Model prior
to and following surgery to correct foot deformity. Only those variables not
directly influenced by foot surgery were assessed. Any that spontaneously
corrected following foot surgery were identified as compensations. Pelvic
rotation, internal rotation of the affected hip and external rotation of the
non-affected hip tended to spontaneously correct. Increased hip flexion on the
affected side, along with reduced hip extension on the non-affected side also
appeared to be compensations. It is likely that forefoot supination occurs
secondary to deviations of the hindfoot in the coronal plane. Abnormal activity
in the tibialis anterior muscle may be consequent to tightness and overactivity
of the plantarflexors. On the non-affected side, increased plantarflexion during
stance also resolved following surgery to the affected side.
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