Did you know that 1 in every 345 children is diagnosed with cerebral palsy (CP)? Among them, gait abnormalities are one of the most common challenges. These walking issues can vary widely—from a child who tiptoes to children who require walking aids for gait optimisation.
Cerebral palsy affects posture and movement due to damage to the developing brain, often before or during birth. As a result, a child may experience impact on their mobility with delayed or difficulty in walking.
This article helps parents understand gait problems in cerebral palsy, recognise early signs, and explore treatment options for better mobility and independence.
Is your child facing an orthopaedic problem?
A] What is Cerebral Palsy?
Cerebral palsy (CP) is a group of neurological disorders caused by abnormal brain development or brain damage during pregnancy, birth, or shortly after. It primarily affects muscle tone, posture, and movement.
There are several types:
- Spastic CP (most common): Tight, stiff muscles
- Dystonic CP: Involuntary movements
- Ataxic CP: Poor coordination and balance
- Mixed CP: Combination of the above
The condition is lifelong, but early therapy and medical interventions can significantly improve outcomes. Understanding how brain injury affects motor control is the first step toward managing gait problems in cerebral palsy effectively.
B] Understanding Normal vs. Abnormal Gait in Children
Most children begin walking between 9 and 18 months. A typical gait pattern involves coordination between muscles, bones, nerves, and balance centers. Healthy walking includes:
- Alternating leg and arm swings
- Heel-to-toe steps
- Smooth forward motion
But when a child has cerebral palsy, this coordination may be disrupted. You may notice:
- Persistent toe-walking after age 2
- Knees crossing over (scissoring)
- Limping or stiffness in one leg
- Excessive falling or unsteady steps
If your child isn’t reaching gait milestones or if something feels “off,” don’t brush it off as clumsiness. These could be early signs of a gait disorder associated with cerebral palsy and should be assessed promptly.
C] What Are the Common Gait Problems in Cerebral Palsy?
I. Spastic Gait Patterns
- Scissoring gait: Legs cross over each other due to muscle tightness in the thighs. It can cause balance issues and falls. (scissoring gait causes include high muscle tone and poor hip control.)
- Equinus gait (toe walking): Common in spastic CP, where the child walks on toes due to calf muscle tightness.
- Crouch gait: Knees and hips remain bent while walking. Causes early fatigue with diminished walking distance.
- Stiff-knee gait: Difficulty bending the knee during walking leading to shorter steps with greater energy expenditure.
II. Other Gait Abnormalities
- Ataxic gait: Wide-based, unsteady steps due to poor balance.
- Hemiplegic gait: One side of the body is affected leading to an asymmetric gait pattern.
- Diplegic gait: Both legs are stiff; walking may appear narrow or scissoring.
- Quadriplegic gait: All four limbs are involved; mobility may be severely limited or require assistive devices.
D] What Leads to Abnormal Gait in Cerebral Palsy?
The root cause lies in early brain injury affecting areas responsible for muscle control, balance, and coordination. Depending on where and how severe the damage is, the child may exhibit various abnormal gait patterns.
Secondary issues worsen gait, such as:
- Spasticity: increased muscle tone
- Contractures: shortened muscles and tendons
- Muscle weakness
- Skeletal malalignments
As children grow, these challenges may evolve. Their bones may grow faster than their muscles, leading to increased difficulty.
E] How Is Abnormal Gait Diagnosed and Assessed?
Early detection makes a world of difference. Paediatricians and neurologists usually begin with a clinical exam—observing how your child walks, stands, and moves.
They may use observational gait assessment tools, video recordings, or motion-capture systems to analyse walking in detail. Gait analysis assessments are often done in specialised clinics with input from:
- Paediatric orthopaedic surgeons
- Physical therapists
- Neurologists
- Occupational therapists
This multidisciplinary approach ensures a well-rounded diagnosis and treatment plan. If you’re concerned, don’t hesitate to seek Dr. Assad Qureshi, a paediatric orthopaedic, especially if mobility is declining or pain is present during walking.
F] What Are the Treatment Options for Gait Disorders in Children?
I. Non-Surgical Treatments
These are often the first line of support for gait disorder in children:
- Physical therapy and gait training: Helps improve muscle strength, flexibility, and coordination. Therapists may use treadmill walking or assisted movement devices.
- Occupational therapy: Focuses on fine motor control and daily functional mobility like getting dressed or climbing stairs.
- Orthotic devices: Braces like AFOs (ankle-foot orthoses) help support proper alignment and prevent contractures.
- Botulinum toxin injections: Temporarily reduce spasticity in overactive muscles, often used with therapy.
- Medications: Muscle relaxants or anti-spastic drugs may be prescribed to improve walking function.
II. Surgical Interventions
When conservative treatments aren’t enough, surgery may help realign joints or reduce spasticity:
- Single-event multilevel surgery (SEMLS): Multiple corrective procedures in one session—efficient and less traumatic.
- Selective dorsal rhizotomy (SDR): Involves cutting nerve fibers to reduce leg spasticity.
- Tendon transfers and lengthening: Adjust muscles or tendons to enhance movement range.
- Osteotomies: Bone surgery to fix alignment, especially in the hips, knees, or ankles.
Surgery is considered when walking is painful, severely limited, or not improving with therapy. Discuss these options with your medical team and ensure any decision aligns with long-term mobility goals.
Conclusion
If your child has cerebral palsy, recognising and treating gait abnormalities early can improve both physical function and quality of life. With the right mix of therapy, technology, and surgery, children with CP can achieve amazing progress.
Your role as a parent is vital—staying observant, informed, and proactive can shape the path toward better mobility and independence.
If you’ve noticed unusual walking patterns or concerns about your child’s gait, don’t wait. A paediatric orthopaedic surgeon in Dubai can make all the difference in their future.
Let’s give every child the chance to walk, run, and thrive confidently.
Dr. Assad Qureshi
Dr. Assad Qureshi is a highly experienced Pediatric Orthopedic Surgeon specializing in musculoskeletal disorders in children. With a focus on early diagnosis and advanced surgical techniques, he is committed to restoring function and improving the quality of life for his pediatric patients.