Cerebral palsy is an umbrella term for a group of neurological disorders that primarily affect a person's movement, muscle tone, and
posture. It is caused by damage to the developing brain, usually during pregnancy or shortly after birth, although it can also occur during
early childhood. Brain damage can occur due to various factors, such as infections, restricted blood flow and hence a lack of oxygen to the
brain, or brain abnormalities. Speech and communication are also often affected in Cerebral Palsy, with some potentially being affected by
intellectual disabilities, seizures, sensory impairments, or other medical conditions. Cerebral Palsy is the most common physical disability
in childhood here in Australia, with a child being born with Cerebral Palsy every 20 hours.
How Does Cerebral Palsy Affect Your Feet And Legs?
The effects of Cerebral Palsy vary from person to person, and can range from mild to severe. Currently in Australia, of those with Cerebral
Palsy, one in three cannot walk, one in three has a displaced hip, and one in two is experiencing chronic pain. Common effects on the feet
and legs include:
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Spasticity: spastic cerebral palsy, which is the most common type occurring in up to 80% of those affected, is
characterised by increased muscle tone, which leads to stiffness and tightness in the muscles. This can cause muscle imbalances and
contractures, leaving a person with poor flexibility and restricted movement. 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.
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Abnormal muscle tone: in addition to spasticity, cerebral palsy can also involve other types of abnormal muscle tone, such
as hypotonia (low muscle tone) or dystonia (involuntary muscle contractions). These can cause floppy muscles or
uncontrolled movements that make walking and maintaining proper foot alignment challenging.
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Gait abnormalities: many individuals with cerebral palsy have gait abnormalities due to muscle imbalances and coordination
issues. These abnormalities can include toe-walking (walking on the toes), scissoring (legs crossing in a scissor-like pattern), or an
irregular and unsteady gait. Gait abnormalities can affect balance, stability, and overall mobility.
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Foot deformities: the increased muscle tone and muscle imbalances associated with cerebral palsy can lead to the
development of foot deformities including ankle equinus (inability to flex the foot upward), varus deformities (inward turning of the foot),
valgus deformities (outward turning of the foot), or clubfoot (foot turned inward and downward) - all of which will affect a person’s
gait.
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Balance and coordination issues: Cerebral Palsy can affect the ability to maintain balance and coordinate movements, making
it challenging to stand, walk, or perform activities that require precise foot and leg control. This creates an ataxic gait,
producing unsteady and staggering movements.
Common foot problems that our podiatrists see and help manage that affect the feet specifically include:
- Foot and ankle weakness
- Foot and ankle stiffness
- Toe walking
- Clubfoot (equinovarus deformity)
- Foot drop
- Flat feet
- High arches
- Muscle tightness
- Feet that excessively turn inwards or outwards
- Claw toes
Common Cerebral Palsy Leg Problems
In the legs, the signs and symptoms can present as:
Alongside these, children may fail to reach their developmental milestones including walking, sitting and crawling. While the effects of
Cerebral Palsy are permanent, the degree to which a person is affected can and does change over time. Some may experience declines in their
balance, muscle tone and other functions, while others may see their function improve. This is why it’s important to have a
personalised management plan for Cerebral Palsy that carefully considers a person’s unique circumstances, effects and their severity -
as this will greatly dictate and change the best treatment approach for them.
While
Cerebral Palsy is typically diagnosed by your doctor using a range of testing paired with medical imaging studies, our podiatrists work
extensively with those with Cerebral Palsy to understand and diagnose how their feet and legs are being affected, so we know the best
ways that we can help.
We’ll conduct a comprehensive assessment of the feet and legs, looking at muscle tone, gait, balance, alignment in the hips, knees,
ankles and feet, and also evaluating for common lower limb problems such leg length differences, clubfoot and much more.
How We Help Treat Cerebral Palsy Feet & Leg Problems
We work uniquely on a case-by-case basis with those with Cerebral Palsy, creating personalised management plans based entirely on the
results of our assessment, which is reflective of the extent and ways that Cerebral Palsy is affecting a certain person. A lot of the work
we do involves using non-surgical, reliable therapies to assist with gait and movement, flexibility, stability, balance and comfort on the
feet. These may include:
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Ankle foot orthotics
(AFO’s) -
AFOs are custom orthotic devices that do an excellent job of controlling both the foot and ankle to enable movement. For children with
Cerebral Palsy, we often use the Supramalleolar orthoses (SMO), which work brilliantly for those with low muscle
tone and stability problems, helping them optimise their gait, movement and their quality of life.
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EXO-UP brace - the EXO-UP is our leading brace for neurological conditions that lead to foot drop and general ankle
weakness. It actually works with your footwear, giving you all the support while maintaining a discreet and minimal appearance. Like all our
custom braces, it is made following a 3D scan of your foot and ankle, and is paired with the results of your assessment to offer you the
best, personalised support.
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EXO-L brace - where
ankle instability is a key problem, we may prescribe the EXO-L brace - a custom brace that is proven to prevent 90% of all ankle sprains.
Often this will be used together with custom foot orthotics (below).
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Custom foot orthotics - in
milder cases of Cerebral Palsy where an AFO is not warranted, we may use custom foot orthotics to best support the feet during gait, adding
comfort and stability, and incorporate custom areas of off-loading for high-pressure areas, helping preserve foot health and well-being.
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Physical therapy - with muscle tightness and weakness as two common effects of Cerebral Palsy, we always consider the
benefits that a customised physical therapy program can offer. This involves strengthening, stretching and balance exercises (where safe and
appropriate) to best support a person’s gait and lower limb function.
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Footwear and footwear modifications
- your
footwear can either help support your stability, balance and comfort - or hinder it, which is why selecting the right footwear is of utmost
importance. Not only do our podiatrists ensure that you’re in the best footwear given the symptoms you’re experiencing and your
current movement capabilities, but we also offer an extensive range of footwear modifications that can further optimise your gait and reduce
the strain on your feet. A common example is a rocker bottom sole to more easily guide you through every step, reducing the strain and
effort needed.
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Mobilisation therapy - stiff, misaligned or
dysfunctional joints may at times benefit from gentle mobilisation therapy to help optimise their alignment and function. We’ll
discuss whether mobilisation therapy could be right for you based on the results of your assessment.
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MLS laser for pain relief - for
the one in two people with Cerebral Palsy that are experiencing chronic pain, or those experiencing other foot and leg pains, we may
recommend the MLS laser. This is a safe, effective and painless treatment that can make a big difference in helping reduce pain and
improving quality of life. There is also research to show that the laser can help improve a person’s bone density, another potential
problem in Cerebral Palsy, as well as helping with muscular contractions.
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Skin and nail care appointments -
the effects of Cerebral Palsy on the feet paired with the pressure of walking can create painful problems such as corns, calluses, nail
thickening, and more. Our podiatrists can reduce calluses, remove corns and provide superior nail care that can help maintain the health and
integrity of your feet.
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Referrals - Cerebral Palsy is a complex and multifaceted condition that can change and affect people in a very wide range
of ways. As such, it’s important to work with a team of health professionals that are skilled in managing Cerebral Palsy. We have a
strong network of health professionals we can refer you to when we identify further needs - like seeing an occupational therapist for
greater mobility inside your home, performing tasks like walking up and down the stairs
FAQs
Are you a registered NDIS provider?
Absolutely. Under NDIS we can offer you a range of devices such as custom foot orthotics, AFOs and custom braces under the assistive
technology support. For many people, this greatly improves their mobility, independence and quality of life.
Which type of cerebral palsy affects both legs?
This is called diplegia. Diplegic cerebral palsy tends to primarily involve the lower limbs. It is characterised
by spasticity (increased muscle tone), muscle stiffness, and difficulties with motor control and coordination in the legs.
What is spasticity in cerebral palsy legs?
Spasticity in cerebral palsy legs refers to the increased muscle tone or stiffness experienced in the foot and leg muscles. In individuals
with cerebral palsy, the messages from the brain to the muscles are disrupted, leading to excessive contraction of the muscles. This
spasticity can affect one or both legs, causing difficulties with movement, coordination, and muscle control. The increased muscle tone can
result in muscle imbalances, contractures, and challenges with walking, balance, and mobility.
While
Cerebral Palsy is typically diagnosed by your doctor using a range of testing paired with medical imaging studies, our podiatrists work
extensively with those with Cerebral Palsy to understand and diagnose how their feet and legs are being affected, so we know the best
ways that we can help.