Risk factors contributing to crouch gait in children with spastic cerebral palsy

Background: Crouch gait is often observed in children with spastic cerebral palsy (CP). This pathological walking pattern can cause abnormally high stress to the knee anatomical structures, leading to various knee problems. Consequently, the ambulatory function of many of these children may eventually regress to depending on assistive walking aids or wheelchairs.

Objectives: The purpose and the focus of this review paper are to understand how risk factors contribute to crouch gait in children with spastic CP.

Major Findings: The risk factors include weakness, tightness, and/or spasticity of muscles, loss of plantarflexion/knee-extension (PF/KE) couple due to inaccurate surgical lengthening of the soleus, lever-arm dysfunctions (LADs) due to femoral and tibial torsion deformities, and foot instability. The analyses suggest that these risk factors contribute to crouch gait by directly or indirectly reducing the extensor control of the lower limbs during the stance phase of gait.

Conclusions: The risk factors identified in this review may not necessarily lead to crouch gait if proactive measures to prevent these risk factors are rendered, especially with the use of instrumented gait analysis (IGA).