Free Footwear Health Check
2015-08-03 18 35 25-s

What is our understanding when we pass by a person who is walking awkwardly?

It could be that the person has spastic cerebral palsy.

The Cerebral Palsy Alliance website www.cerebralpalsy.org.au is bright, easy to navigate and extremely informative. The following excerpts have been taken from the site.

Spastic cerebral palsy is the most common type of cerebral palsy. The muscles of people with spastic cerebral palsy appear stiff and their movements may look stiff and jerky.

Spasticity is a form of hypertonia, or increased muscle tone. When people without cerebral palsy perform a movement, some groups of muscles turn on and some groups of muscles turn off. In people with spastic cerebral palsy, both groups of muscles may become turned on at the same time. In some instances the wrong muscle groups may turn on. This makes movement difficult or even impossible.

In cerebral palsy, spasticity is due to damage to the motor cortex of the brain before, during or after birth. This part of the brain is considered the supreme command centre for control of body movements.

Spasticity may affect any muscle group in the body however there are some common patterns that are seen in cerebral palsy.

Effect on the lower limbs (legs)
If spasticity affects one or both of the legs it can lead to:

  • Flexion at the hip (which causes the leg to lift upwards when lying or the body to lean forwards in standing)
  • Adduction or ‘scissoring’ of the thighs (which causes the legs to pull together)
  • Flexion at the knees (causing changes in a person’s standing posture)
  • Equinovarus foot posture (where the toes point downwards and inwards with the heel off the ground – this results from tightness in the calf muscles)
  • Hyperextension of the big toe (where the toe is pulled upwards and backwards towards the shin)

Spasticity in the muscles of one or both legs may affect a person’s ability to

  • Stand upright
  • Sit upright
  • Transfer from one position to another
  • Move and reposition in bed
  • Walk and run

So what can it mean for a person with cerebral palsy with regard to their footwear and / or other devices? We see a range of people at Happy Feet Pedorthics who have cerebral palsy. Footwear for this group of people can mean:

  • Prefabricated medical footwear, including the Piedro and Keeping Pace ranges of footwear
  • Fitting of devices
    • Ankle Foot Orthoses
    • subtalar control foot orthosis
  • Fitting of orthotics
    • Accommodative
    • sensomotoric
    • functional
  • Custom made shoes
  • Modifications to the footwear
    • Carbon fibre plates – to keep the shoe stiff to aid the gait
    • Internal or external wedges – to maximise alignment to the body from the feet up
    • Rocker soles – to support the person to roll through in their gait cycle
    • Hook and loop closures – easier than tying up laces especially when the hands have also been affected by the cerebral palsy
    • Sole and Heel flares – to improve balance in the footwear
  • Regular repairs to the footwear

Clare Nelson C Ped CM AU