Crouch Gait: Evaluation and Management
Volume 10 | Issue 1 | January-April 2024 | Page: 20-25 | Hitesh Shah, Dhiren Ganjwala
DOI- https://doi.org/10.13107/ijpo.2024.v10i01.173
Submitted: 08/02/2024; Reviewed: 28/02/2024; Accepted: 17/03/2024; Published: 10/04/2024
Authors: Hitesh Shah MS Ortho [1], Dhiren Ganjwala MS Ortho [2]
[1] Department of Paediatric Orthopaedics, Kasturba Medical College, Manipal, Manipal academy of higher education, Manipal, Karnataka,
[2] Ganjwala Orthopaedic Hospital, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Dhiren Ganjwala,
Ganjwala Orthopaedic Hospital, Ahmedabad, Gujarat, India.
E-mail: ganjwala@gmail.com
Abstract
Crouch gait, a common gait abnormality in spastic diplegia, is characterized by increased knee flexion, ankle dorsiflexion, and reduced hip extension during the stance phase. It occurs due to impairments in anti-gravity muscles and is often aggravated during adolescence due to growth spurts. The condition can result from factors such as lever arm dysfunction, joint deformities, muscle elongation, and weakness. Crouch gait significantly affects mobility, causing early fatigue, patellar tendon elongation, and potential arthritis. Prevention involves strengthening anti-gravity muscles, maintaining proper weight, and using orthoses to correct deformities. Treatment options include surgical interventions like osteotomies, tendon lengthening, and patellar tendon advancement to address deformities and restore function. Non-surgical methods include muscle-strengthening exercises and the use of appropriate orthoses. A comprehensive assessment of modifiable and non-modifiable factors is crucial for tailored management, ultimately improving gait and reducing energy expenditure during walking.
Keywords: Crouch gait, Cerebral palsy, Patella alta, Planovalgus foot, Knee fixed flexion deformity
References
1. Gage JR, editor. The treatment of gait problems in cerebral palsy. 2nd ed. London: Mac Keith Press; 2004. Treatment principles for crouch gait; p 382-97.
2. Schwartz M, Lakin G. The effect of tibial torsion on the dynamic function of the soleus during gait. Gait Posture. 2003;17:113-8.
3. Hicks J, Arnold A, Anderson F, Schwartz M, Delp S. The effect of excessive tibial torsion on the capacity of muscles to extend the hip and knee during single-limb stance. Gait Posture. 2007;26:546-52.
4. Perry J, Antonelli D, Ford W. Analysis of knee joint forces during flexed knee stance. J Bone Joint Surg Am. 1975;57:961-7.
5. Rosenthal RK, Levine DB. Fragmentation of the distal pole of the patella in spastic cerebral palsy. J Bone Joint Surg Am. 1977;59:934-9.
6. Topoleski TA, Kurtz CA, Grogan DP. Radiographic abnormalities and clinical symptoms associated with patella alta in ambulatory children with cerebral palsy. J Pediatr Orthop. 2000;20:636-9.
7. Klatt J, Stevens PM. Guided growth for fixed knee flexion deformity. J Pediatr Orthop. 2008;28:626-3
8. Gage JR, Stout JL, Novacheck TF, Matsuo K. Distal femoral extension osteotomy and patellar advancement for crouch in cerebral palsy J Bone Joint Surg Am. 2008, 90:2470-84
9. Ganjwala D, Shah H. Management of the Knee Problems in Spastic Cerebral Palsy. Indian J Orthop. 2019 Jan-Feb;53(1):53-62.
10. Das SP, Pradhan S, Ganesh S, Sahu PK, Mohanty RN, Das SK. Supracondylar femoral extension osteotomy and patellar tendon advancement in the management of persistent crouch gait in cerebral palsy. Indian J Orthop. 2012 Mar;46(2):221-8.
11. Joseph B, Reddy K, Varghese RA, Shah H, Doddabasappa SN. Management of severe crouch gait in children and adolescents with cerebral palsy. J Pediatr Orthop. 2010 Dec;30(8):832-9..
12. Ganjwala D. Multilevel orthopedic surgery for crouch gait in cerebral palsy: An evaluation using functional mobility and energy cost. Indian J Orthop. 2011 Jul;45(4):314-9.
13. Rodda JM, Graham HK, Nattrass GR, Galea MP, Correction of Severe Crouch Gait in Patients with Spastic Diplegia with Use of Multilevel Orthopaedic Surgery J Bone Joint Surg Am. 2006, 88:2653-64.
14. Mohan V, Ganjwala D, Singh K, Shah H. Evaluation of a technique of patellar tendon shortening to correct patella alta associated with severe crouch gait in cerebral palsy. J Pediatr Orthop B. 2023 Jan 1;32(1):87-93.
| How to Cite this Article: Shah H, Ganjwala D | Crouch Gait: Evaluation and Management International | Journal of Paediatric Orthopaedics | January-April 2024; 10(1): 20-25 https://doi.org/10.13107/ijpo.2024.v10i01.174 |
