Helping Feet Affected By Cerebral Palsy

Helping Feet Affected By Cerebral Palsy

Every 15 hours, a child in Australia is born with cerebral palsy (CP). CP is currently the most common physical disability in childhood, where the signs become evident within the first 12-18 months of a child’s life, and the effects are life-long. When it comes to the feet and legs, CP can significantly affect a person’s mobility and independence. Here at The Podiatrist, we work alongside a multi-disciplinary care team to help those affected decrease their pain and improve their comfort when walking and moving – interventions which can play a large role in maintaining their quality of life. Today, we thought we’d share the ways we help, as well as fill you in on CP and how it impacts the lower limbs.

Cerebral Palsy: The Background

CP is a term for a group of disorders that affect a person’s motor function, meaning 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. The effects of CP are permanent, but they can change over time. Every case of CP also has a different 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 & Legs in CP

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:

1. Spastic CP = Stiff Muscles

Approximately 80% of those with CP have spasticity. Spastic CP 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.

2. Dyskinetic CP = Uncontrollable Movements

Dyskinesia is characterised by involuntary muscle movements, whether they are jerky or very slow. This makes walking difficult and unpredictable.

3. Ataxic CP = Balance & Coordination Problems

Many 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
  • Treating Feet Affected By Cerebral Palsy

We can help those affected by CP 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:

  • Ankle foot orthotics (AFO’s) & foot orthotics – AFO’s are orthotic devices that control both the foot and ankle. They are the most common type of orthotic used in children with CP and are proven to be effective in helping those affected reach their treatment goals. They are custom-made to improve foot and leg function and help manage muscle contractions, weakness and other problems. 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 CP, 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

Need help from an experienced, passionate team?

Here at The Podiatrist, we’re all about helping you realise your full potential. We’ve been helping residents of Toowoomba & Darling Downs look after their foot and leg health for over 20 years. Book your appointment online or call us on (07) 4638 3022

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The bones at this Lisfranc joint are connected by a tough band of tissue (ligament) that keeps the bones aligned in the right place (instead of popping up and down whenever!). It also helps to strengthen this area of the foot, which is vital for arch stability and for walking. 

Injuries at the Lisfranc joint can come in the form of sprains, fractures or dislocations. Thankfully, this type of injury isn’t all too common, but is definitely something that our podiatry team comes across from time to time and can be extremely debilitating for a patient if left untreated.

It should be noted that Lisfranc injuries can be overlooked or misdiagnosed if your practitioner is unfamiliar with this problem. All our clinical staff at The Podiatrist specialise in leg and foot function and injury, so know how to spot this problem and how best to help you recover. 

So, how could I have sustained a Lisfranc injury?

Lisfranc injuries typically occur either directly or indirectly. Direct injuries are the most common, caused by excessive force being applied to the end of the foot. This tears the supporting ligaments and can dislocate or fracture a bone, examples of direct injury causes include:

  • A heavy object falling on the foot
  • Falling from a high height
  • Car accidents
  • Kicking a hard object, particularly if it’s stationary

Indirect injuries result from overloading (putting excessive pressure through) the midfoot, which often occurs through either twisting the foot abnormally, or from impact to the midfoot. Anything that twists and overloads the midfoot can cause a Lisfranc injury, like:

  • Running where twisting of the foot and falling occurs
  • Missing a step on a staircase

What do Lisfranc injuries feel like?

Painful! You’ll likely know that something has gone wrong quickly after sustaining the injury, and may start to feel:

  • Midfoot pain, tenderness or throbbing
  • Swelling or redness
  • Bruising on the bottom of the foot after a couple of hours
  • Pain on standing, weight-bearing and physical activity

How should these injuries be treated?

The first thing you want to do is reduce your pain and discomfort. We recommend using the PRICE (protection, rest, ice, compression, elevation) principles. Avoid any movements that cause pain, including walking on the injured foot, as much as possible. Ice, compression and elevation will help reduce your swelling, which will reduce your pain and help you feel more comfortable.

Your treatment will then depend on how severe the injury to your Lisfranc joint is – which we’ll be able to give you an idea of when you come in to get it assessed and diagnosed. Getting your foot seen to if you have midfoot pain is a must as there are many causes of midfoot pain, and different causes require diffrent approaches to treatment.

Your care will differ depending on whether you’ve sustained a ligament sprain, fracture or dislocation. Midfoot sprains do take significantly longer to heal than regular ankle sprains, so don’t put pressure on your recovery.

When standing, the midfoot supports approximately 2-3 times a person’s body weight, so reducing this pressure and minimising weight-bearing at the midfoot is a key part of your treatment. We’ll focus on isolating the damaged structures of the foot and giving them time to heal, then slowly re-introducing weight-bearing and strengthening. Your care may include:

  • A range of full and partial casts and boots
  • Crutches
  • Orthotics to offload pressure as the injury heals
  • Footwear assessment to ensure shoes are helping and not hindering recovery
  • Physical therapy as the foot heals to strengthen affected muscles

Severe injuries where the joint is unstable may require surgical intervention. There are a number of different surgical options and we can refer you for a consultation with a surgeon to discuss the best one for you. 

What’s the verdict – how long will it take to recover?

If you’re going to take away one thing from reading this information, let it be this: Lisfranc injuries do take a while to heal and you are very susceptible to re-injury if you return to regular activities too early and end up overloading your midfoot again. 

Conservative treatment may involve restricting the foot to a variety of boots for up to 3 months before switching to custom orthotics beyond this. Athletes may require a recovery period of 6-12 months before returning to competitive activity.

We understand how important it is to be able to walk and play without pain so if you’re worried about your feet or you’ve suffered an injury – whether it’s painful or not – we’d love to help. We’ve been helping our community in Toowoomba & Darling Downs for over 20 years. To book an appointment, call us on (07) 4638 3022 or book your appointment online here.

References:

  • [1]Seybold JD, Coetzee JC. Lisfranc injuries: When to observe, fix, or fuse. Clinical Sports Medicine 2015;34(4):705–23
  • [2]Baquie P, Fooks L, Pope J, Tymms G. The challenge of managing mid-foot pain. Australian Family Physician 2015;44(3):106–11
  • [3]Welck MJ, Zinchenko R, Rudge B. Lisfranc injuries. Injury 2015;46(4):536–41
  • [4]Seybold JD, Coetzee JC. Lisfranc injuries: When to observe, fix, or fuse. Clinical Sports Medicine 2015;34(4):705–23
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