Diplegic spastic cerebral palsy affects both lower limbs . It also features some functional problems in upper limb. Lower limb affection is more than upper limb. In initial age most commonly they are present in jump knee (toe walking) & scissor gait but after growth spurt in adolescent their gait presentation may change to crouch gait. They can present in variety of manner.
Problem: Crouch gait can occur because of many factors like overstretched / over lengthened calf muscle, tight knee flexor & rotational deformity of leg & foot. This gait pattern is very much cumbersome and need lot of energy. With increase in weight & height crouching can also increase.
Management Protocol: This gait pattern should be prevented at all costs and if it happens then it should be managed at earliest to prevent rapid deterioration in gait pattern. In early childhood (< 6 year) CP child physiotherapy, proper brace & Cerebral Palsy botulinum toxin helps lot in controlling this problem. During pubertal growth spurt, rapid progression of crouching can occur. This rapid progression occurs because of increasing weight, contracture of hamstring muscle & overstretching of gastrocnemius. Then these children need urgent attention and can be managed by hamstring lengthening with strengthening of knee extensor & calf muscle followed. Later on they may need osteotomy in distal thigh and transfer of tibial tuberosity. Rotational deformity of leg & feet also need correction in same stage. These Children also need Floor reaction orthosis (FRO) & strength training exercise of quadriceps & gastroc-soleus muscle for long duration even after surgery.