Equinus deformity as a compensatory mechanism for ankle plantarflexor weakness in cerebral palsy

A theory for equinus gait in cerebral palsy (CP) is that the strong plantarflexors prevent the weak dorsiflexors from achieving dorsiflexion, thereby causing the ankle to be in a plantarflexed position. Recent work has indicated that both the ankle dorsiflexors and plantarflexors are weak. The purpose of this research was to theoretically and experimentally demonstrate that equinus deformity gait could be a compensatory strategy for plantarflexor weakness. It was hypothesized that children with CP utilize an equinus position during gait as a consequence of their weakness. A two-dimensional, sagittal plane model estimating plantarflexor forces through the Achilles tendon was developed. Five able-bodied (AB) children were tested utilizing heel-toe and progressively increasing toe walking strategies. Four children with CP were tested as they walked using their equinus gait. Results demonstrated that AB children assuming the toe walking stance progressively reduced the plantarflexor force when compared to their heel-toe walking trials. However, their toe walking strategy could not reduce the plantarflexor force level to that of the children with CP during the gait cycle. It was concluded that the equinus deformity posture complemented the CP children's plantarflexor weakness. Therefore, by implementing a concomitant strategy to maintain a reduced force state, equinus deformity could be used as a compensatory mechanism for individuals with plantarflexor weakness.