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) physiotherapy, proper brace & 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.
