If you’re reading this, it’s likely that you’ll already know that Cerebral Palsy (CP) describes a group of movement disorders that start in early childhood. While at this young age kids can move independently, they do so with significantly more difficulty, having 52% or less maximum contractile force in the feet and legs compared to same-aged children without CP. In the majority of those affected, this greatly affects their ankle stability, as we rely on the strength of our ligaments and muscles surrounding the ankle to help us walk smoothly, confidently and with ease.

Here at Sole Motion, we work with both children and adults to maintain and improve their gait – an important component of which is focusing on their ankle stability. Today, we thought we’d run through some of the ways we do this so you know what to expect as a patient of ours!

 

Ankle Instability & CP: The Background

Before we dive into the solutions, it’s important to understand that ankle instability in those with CP can come about in a number of ways. It may be due to low muscle tone, which results in weakness and excess flexibility, or from high muscle tone, which causes stiffness and spasticity. Either way, these have a significant impact on a person’s walking patterns (gait), ability to walk unassisted, confidence on their feet, falls risk and much more.

Due to these differences, as well as the wide range of muscles & tissues that may be affected at differing severities, every CP patient we treat has a completely unique and 100% tailored treatment plan. This is essential, especially considering the effects extend far beyond the ankle joint. For example, if a person affected by CP has any knee deformities or shortened muscles in the legs, we’ll create a unique approach based on the severity of the problem and the best solution.

 

Our Role In Managing Ankle Stability In Cerebral Palsy

If you’ve never seen a podiatrist before, we focus our careers on helping improve the function of the lower limbs while helping our patients recover from or prevent injury, improve their performance, and treat a number of pains. When it comes to CP, we are part of the important holistic, multi-disciplinary team that work together with our different specialities to help get the best results. Below, we’ve detailed some common evidence-based therapies we use in our care.

 

Ankle-Foot Orthoses (AFO) & Foot Orthotics

An AFO is an orthotic-brace that encompasses the foot, ankle and sometimes the lower leg. It is widely and effectively used to improve ankle stability, balance control and postural reactions. This is different from the traditional foot orthotics used in podiatry, which sit beneath the foot only to alter and improve foot function and hence movement. Both have a place in helping patients with CP, depending on their unique symptoms and requirements.

AFO’s & orthotics can help:

• Improve spastic movement
• Correct, limit or prevent deformities
• Low-tone pronation (fallen arches, outward-turned foot due to muscle weakness)
• High-tone pronation (high arch, outward-turned foot due to increased muscle tone)
• Swing-phase inconsistency (erratic movements in the foot)
• Drop-foot (drop of the front of the foot due to weakness)
• Eversion (outward turn of the foot, “duck-footing”)
• Inversion (inward turn if the foot, “pigeon-toeing”)

 

Here at Sole Motion Podiatry, we are able to prescribe and refer for both custom AFO’s and orthotics to best suit the needs of each patient. While all falling under the umbrella term of ‘AFO’ or ‘orthotic’, each device must be uniquely and carefully designed with a specific patient’s ankle function, muscle strength, gait characteristics and CP characteristics in mind – an area where we excel as lower limb specialists. We’ll help you get the right device with a tailored prescription to help you get the best support and results.

 

Physical Therapy

When we talk about physical therapy, we talk about improving the strength & flexibility of the muscles, tendons and ligaments surrounding the ankle that will make everyday movements easier for those with cerebral palsy. Studies have proven that having a good physical therapy programme can help improve coordination, balance, endurance, pain management, posture and gait – meaning overall improved function and quality of life.

Specifically, by meeting the needs or current deficiencies of the soft tissues in the lower limbs, we are able to help reduce the muscle tension and jerky movements associated with spastic CP, improve muscle tone and hence movement control, and improve the balance issues faced by those with ataxic CP. For example, strength training the ankle plantar flexors (the muscles that help the foot point downwards) has been shown to significantly improve walking speed, cadence and step length.

Starting physical therapy early, like with flexibility exercises in early childhood, can also help prevent painful and debilitating muscle tightening that could require surgical correction in the future.

 

Shoes & Shoe Modifications

Our shoes create the ground we walk on and can add to the support our ankles recieve – or leave them less supported. While we don’t sell shoes in our clinic here at Sole Motion, we can use your assessment findings to recommend the best footwear options for you. These may be regular footwear with firm support around the ankle, or orthopaedic footwear. We’ll also assess if modifications to your existing or new shoes may best assist your ankle stability and movement.

 

Bracing & Splinting

As a less customised and ‘intense’ variant to an AFO, braces or splints are another effective way to help almost instantly improve ankle stability while the results from physical therapy progress. A firm yet comfortable brace that keeps the ankle in a more stable and supported position can help mimic the normal effect of strong ankle-stabilising ligaments that limit side-to-side rolling of the ankle. This can make the wearer feel more comfortable and confident on their feet, improve their ankle stability and gait, and depending on the brace selected, may also help other problems, where present, like foot drop, knee subluxation and more.

 

The Right Referrals

Here at Sole Motion, we’ve built an extensive network of experienced health professionals that genuinely care – and work together to achieve the best results for our patients. This means that for anything that we identify but are not best suited to help with, we’ll refer you to the right person at the right time. This may be a surgeon where a shortened tendon cannot be corrected by physical therapy or an occupational therapist to get the right in-home mobility aids, to name a few.

 

Knowing The Best Step to take, especially when you’ve tried other options can be hard…

… But it’s our job to make the process easy, simple and straightforward for you while providing excellent lower limb care. To book in with our experienced podiatry team in Melbourne’s Point Cook,click here or call us on 1300-FX-FEET