Article

External rotation of the foot associated with mid-foot break is a commonly
observed gait abnormality in diplegic CP patients. Previous studies have shown a
correlation between equinus and internal hip rotation in hemiplegic patients.
This study aimed to determine if there was a correlation between the amount of
transverse plane rotation in diplegic CP patients using kinematic data from
standardised gait analysis. Lower limb data of 134 ambulant children with
diplegic CP was analysed retrospectively determining the maximum change in foot,
hip and pelvis rotation during loading response. Highly significant negative
correlations (P=<0.001) were found between foot and hip movements and foot and
pelvic movements. Equinus at initial contact diminished the foot:hip correlation
while it enhanced the foot:pelvic correlation. There was less external rotation
of the foot in equinus patients (P=0.012) and more external rotation of the
pelvis in the equinus group (P=<0.001). This data reveal a correlation between
transverse plane rotation at foot level to that at the hip and pelvis. The likely
biomechanical explanation is relatively excessive transverse external rotation of
the foot due to abnormalities such as mid-foot break. When under load, where the
foot is fixed to the floor, internal rotation of the entire leg occurs. This is
due to lever arm disease as a result of the relatively shortened foot and
inefficiency of the plantar-flexion knee-extension couple. Equinus modulates the
effect. When treating such patients, lever arm deformities at all levels must be
considered to result in the best outcome and prevent recurrences.
CI - Copyright (c) 2011 Elsevier B.V. All rights reserved.

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