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Cerebral Palsy

 

Approximately 1 in 500 babies in New Zealand are born with Cerebral Palsy, making it the most common cause of childhood disability in the country. As such, it’s a condition that we take very seriously, given the potential complications it may have on a child’s (and adults) ability to stay active and keep doing the things they love and stay independent – particularly with the effects being lifelong and therefore needing effective and leading management.

 

What Is Cerebral Palsy?

Cerebral Palsy is a term for a group of disorders that affect a person’s motor function, meaning their voluntary and controlled movements. These functions are disturbed because of injury to the brain which often occurs during pregnancy or infancy from events that restrict blood flow to the brain, injuries to the brain, or brain infections. While the effects of Cerebral Palsy are permanent, they can change over time. Every case of Cerebral Palsy can also vary greatly in its severity, so symptoms can range from mild, like weakness in one foot, to severe, like the inability to perform voluntary movements. Alongside motor function, other impairments are likely to be present such as speech, visual or learning difficulties.

 

The Feet And Legs In Cerebral Palsy

The effects on the feet and legs are related to which areas of the brain have been affected, as these produce varying problems. There are three common classifications of movement disorders, and a person with CP may be affected by one or more of:

 

  • Spastic Cerebral Palsy: approximately 80% of those with Cerebral Palsy have spasticity. Spastic Cerebral Palsy means that the tone of a person’s muscles is naturally increased, so the muscles shorten, become stiff, and result in restricted movements with poor flexibility. As flexibility and a good range of movement is a key part of a healthy and optimal gait, a person’s movements appear jerky, unbalanced and inefficient.


  • Dyskinetic Cerebral Palsy: dyskinesia is characterised by involuntary muscle movements, whether they are jerky or very slow. This makes walking difficult and unpredictable.


  • Ataxic Cerebral Palsy: many people liken ataxia to a ‘drunken’ gait – it is unsteady, staggering and can lack the quick movements and responses needed to maintain control when walking and moving. Like any form of CP, the severity of these balance and coordination deficits can vary, and if severe, can make daily movement very difficult.

 

 

Knowing the three primary ways that motor function is affected, the specific problems, signs and symptoms with the feet and legs include:

  • In the early years, not reaching regular development milestones such as walking, sitting and crawling
  • Having floppy (flaccid) or stiff and rigid limbs 
  • Weakness in the limbs
  • Jerky or uncontrolled movements
  • Poor balance and unsteadiness
  • Toe walking
  • Ankle movement restrictions
  • Clubfoot (equinovarus deformity)
  • Foot drop
  • Flat feet
  • High arches
  • Contracted muscles
  • A difference in the length of the legs
  • Hip dysplasia

 

Managing The Feet In Cerebral Palsy

As podiatrists with an extensive interest in neurological conditions and injuries, we work to help those affected with Cerebral Palsy with their range of movement and flexibility, and their stability and comfort on their feet by using non-surgical and non-invasive care. These include:

 

  • EXO-braces – we have two types of EXO-braces available: the EXO-L UP and the EXO-L brace. The EXO-L UP is designed for those who develop foot drop, which can occur with Cerebral Palsy. The EXO-L brace is designed for those at risk of ankle sprains and ankle instability, which is also a common occurrence with Cerebral Palsy. Both are custom-prescribed, 3D scanned braces that are lightweight, slimline and have proven efficacy.
  • Ankle foot orthotics (AFO’s) & foot orthotics – AFOs are orthotic devices that control both the foot and ankle. They are a common type of orthotic used in children with Cerebral Palsy and are proven to be effective in helping those affected reach their treatment goals. They are also custom-made to improve foot and leg function and help manage muscle contractions, weakness and other problems, though are much bulkier than EXO-braces. Foot orthotics are designed to support and correct the biomechanical function of the feet only to achieve similar goals, and the right type of orthotic is prescribed depending on a person’s symptoms, their treatment goals and what will benefit them the most.
  • Physical therapy – with muscle tightness and weakness as two common effects of Cerebral Palsy, applying appropriate stretching and strengthening therapies can help improve movement and comfort. These are prescribed on a case-by-case basis and have been proven to be most effective when combined with active movement training. 
  • Footwear – footwear can either help improve stability, balance and comfort – or hinder it. We help our patients select the most suitable footwear for the symptoms they’re experiencing and their current movement capabilities.