Elsevier

Gait & Posture

Volume 57, Supplement 1, September 2017, Pages 64-65
Gait & Posture

Which Part of the Triceps Surae Muscle Contributes More to Functional Foot Equinus in Spastic Hemiplegic CP Gait?

https://doi.org/10.1016/j.gaitpost.2017.06.291Get rights and content

Introduction

Equinus deformity is a common complication of patients who suffer from hemiplegic (unilateral) cerebral palsy. Surgical correction is required to restore foot dorsiflexion. Clinically the gastrocnemii part is usually shorter than the soleus. The general opinion is to spare the soleus and if possible focus on lengthening the gastrocnemii doing a vulpius or strayer procedure in order to preserve force of the plantarflexors and to avoid crouching.

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Research Question

Does the muscle model calculation from inverse dynamics support the common concept?

Methods

All patients from the first cohort study where an Achilles tendon lengthening combined with a tibialis anterior shortening was performed (n = 12) were included and their data anonymised. Patients with too poor data were excluded (10 = patients remained). The data before and at the time for the long-term follow-up study were considered. The gait data were imported a slightly changed Lower Leg extremity Model of AnyBody Technology software. The mean of five trials for every patient was compared

Results

Ankle Dorsiflexion reaches a maximum of 0 degrees at 10% of stance phase preoperatively. Later in stance dorsiflexion decreases, indicating the foot going into equinus position. Postoperatively ankle dorsiflexion was very close to normal with a permanent and significant increase between 0% and 45% of stance phase (Fig. 1).

Preoperatively the function of the soleus muscle was concentric between 10% and 25%, opposite to normals (Fig. 2, arrow, Fig. 3), which changed to an eccentric contraction at

Discussion

This modelling study shows a completely different muscle action of the soleus muscle compared to the gastrocnemii. Our data indicate that - the soleus muscle shows a more abnormal action than the gastrocnemii, and - an Achilles tendon lengthening seems to be an adequate procedure to correct the abnormal soleus action.

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