Development of calcaneal gait without prior triceps surae lengthening: an examination of predictive factors.

BACKGROUND: Although equinus is more common in cerebral palsy (CP), the prevalence of calcaneal gait (CG) has been reported at more than 30% among patients with CP, even in the absence of prior surgical intervention. The goal of this study was to identify patient characteristics predictive of the development of CG in patients without prior triceps surae lengthening.

METHODS: Gait data were reviewed for 58 participants with bilateral involvement owing to CP (116 limbs) who had 2 gait analysis tests with no triceps surae lengthening between tests. None of the patients exhibited CG at the initial gait study. Patients were grouped according to whether or not they exhibited CG patterns at the second test. Factors potentially predictive of calcaneal gait patterns were compared statistically between groups.

RESULTS: CG was shown by 24/116 extremities (21%) at the second study. The CG group experienced greater increase in body weight and body mass index between tests (P=0.006 and 0.03 respectively). Passive dorsiflexion range with the knee flexed was significantly greater in the CG group (P=0.008). The CG group also showed a tendency toward greater plantarflexor weakness, although this only approached statistical significance (P=0.08) likely owing to small sample size. Age, CP subtype, time to follow-up, hamstring range, selective motor control, and gross motor functional level were not predictive.

CONCLUSIONS: Patients who undergo (or have potential to undergo) significant weight gain, and have tendencies toward excessive passive dorsiflexion with the knee flexed may be at risk for development of CG over time. In such patients, treatment regimens should include therapy to maintain or improve plantarflexor strength, and methods to prevent overstretching the plantarflexors. Nonsurgical treatments for triceps surae contractures, such as serial casting, may be preferable, to avoid hastening development of calcaneal crouch gait over time.

LEVEL OF EVIDENCE: Prognostic study---Level III (case-control).