In recent years, interventions to correct crouch gait in patients with Cerebral Palsy have undergone a breakthrough.
Modern treatment principles combined with cutting-edge surgical options have led to results that were unthinkable just a few years ago.
Corrective surgery for crouch gait: an international experience
Dr. Lampasi and the OrthoChildren Center (Bologna, Italy) are among the most experienced international centers in this type of procedure. Our results have been shared at national and international conferences.
The treatment is based on the most modern principles of cerebral palsy management and is in line with the most recent scientific research. For many years, Dr. Lampasi has collaborated with Professor Reinald Brunner of the UKBB in Basel, Switzerland, one of the world’s leading experts in neuroorthopedics.
Crouch gait: why to intervene?
Patients who walk with bent knees and a crouched gait are forced to exert considerable effort to resist the force of gravity. This effort is initially manageable, but over time and as the child grows, it becomes unsustainable, and patients risk losing the ability to walk, preferring to use a wheelchair.
If timely and appropriate intervention is provided, it is possible to restore these patients to a better level of walking autonomy.
Crouch gait in patients with cerebral palsy: beware of simplifications
To achieve the best results in this field, it is necessary to understand the complexity of this pathology and apply appropriate tools to study and treat it.
In recent years, another line of treatment has developed, based on gradual multiple fibrotomy (see fact sheet) and a simplification: that the main problem in these children is muscle contractures and that simply loosening these tensions is sufficient to improve their gait. This treatment principle has been outdated by the international community for some years now and can only be useful in very specific cases.
Our group is one of the few international centers capable of applying both the principles of fibrotomy and the most modern orthopedic surgery techniques. This allows us to distinguish which cases benefit from fibrotomy, which require more complex procedures, and which require a combination of the two techniques.
Crouch gait: is surgery alone enough?
The treatment plan always includes, in addition to surgical planning, also:
- a correct intensive rehabilitation plan (our team collaborates with high-level intensive rehabilitation centers)
- appropriate orthoses (the experienced surgeon must know and prepare the most appropriate orthosis for post-operative recovery)
Crouch gait: Is it spasticity’s fault?
In the past, treatment was based on repeated inoculations of botulinum toxin, the indication of selective rhizotomies, etc., to try to reduce spasticity.
The validity of this approach has now been undermined.
Crouch Gait: Is it the fault of shortened muscles and tendons?
The “classic” approaches aim at generously lengthening the muscles and tendons of these children (fibrotomies, tenotomies, etc.).
This type of approach is ineffective in many cases or can even lead to a worsening of the situation.
Crouch gait in patients with Cerebral Palsy: what surgical interventions are available?
The procedures performed at our Center may include one or more of the following options:
- Multiple fibrotomies, isolated or combined with other procedures: see dedicated sheet
- Correction of foot deformities (mild to severe)
- Correction of knee deformities (fibrotomies, tendon lengthenings, femoral osteotomies, epiphysiodesis, etc.) and correction of patella alta
- Hip deformity correction
- Correction of rotational deformities
Please refer to the factsheet on functional orthopedic surgery for further details.
Patients from abroad: can OrthoChildren Center treat foreign patients?
Yes, many patients come from all countries (Europe and USA):
- the surgical equipe has a wide experience with these procedures
- an intensive rehabilitation program can be included
- the procedure is less expensive than in USA and other countries
- Families take advantage of this opportunity to combine a trip to the beauties of Italy