Toe walking in children with cerebral palsy: a possible functional role for the plantar flexors

Abstract

Equinus and toe walking are common locomotor disorders in children with cerebral palsy (CP) walking barefoot or with normal shoes. We hypothesized that, regardless of the type of footwear, the plantar flexors do not cause early equinus upon initial foot contact, but decelerate ankle dorsiflexion during weight acceptance (WA). This latter action promoted by early flat-foot contact is hypothesized to be functional. Hence, we performed an instrumented gait analysis of 12 children with CP (Gross Motor Function Classification System class: I or II; mean age: 7.2 years) and 11 age-matched typically developing children. The participants walked either barefoot, with unmodified footwear (4° positive-heel shoes) or with 10° negative-heel shoes (NHSs). In both groups, wearing NHSs was associated with greater ankle dorsiflexion upon initial foot contact, and greater tibialis anterior activity (but no difference in soleus activity) during the swing phase. However, the footwear condition did not influence the direction and amplitude of the first ankle movement during WA and the associated peak negative ankle power. Regardless of the footwear condition, the CP group displayed (i) early flattening of the foot and ample dorsiflexion (decelerated by the plantar flexors) during WA, and (ii) low tibialis anterior and soleus activities during the second half of the swing phase (contributing to passive equinus upon foot strike). In children with CP, the early action of plantar flexors (which typically decelerate the forward progression of the center of mass) may be a compensatory mechanism that contributes to the WA's role in controlling balance during gait.

Feature Selection using Random Forest Classifier for Foot Strike Event Detection in Toe Walkers

“…When the heel is unable to contact the floor at the explicit beginning of stance phase or the absence of first heel rocker is defined as toe walking [21] [22] [23] [24] [25]. Toe walking is observed to be a common disorder in hemiplegic children and diplegic children with Cerebral Palsy [21] [22] [23] [24] [25]. Gait Analysis results in collection of high number of kinematic parameters.…”

Conservative therapy and physiotherapy in children with toe walking: a systematic review

“…10 Children with CP have flat caused of the reduced plantar activity in the second part of the swing phase. 11 Muscular dystrophy is a genetic condition with several variants. Each has its unique genetic pattern, onset duration, and rate of muscle loss and weakness.…”

Effects of Vojta Therapy on the Motor Function of Children with Neuromotor Disorders: Study Protocol for a Randomized Controlled Trial

“…These compensatory strategies must be identified and considered in rehabilitation programs for CP children. These aspects may be improved with rehabilitative interventions focusing on postural control and trunk activity [18,19].…”

“…Intervention group: patients under Vojta Therapy intervention [17][18][19][20][21][22][23][24][25][26][27][28]…”