Rotational Problems: CP

Although not readily apparent to the untrained eye, the position of the foot with respect to the leg is helpful
in extending the knee. When distorted, this relationship is often referred to as ‘lever arm’ disease.
Likewise, the position of the knee with respect to the axis of the hips is also important in gait progression so there is not excessive ‘kneeing in.’ Why correct such deformities? Severe kneeing in or scissoring may
impede one leg from moving ahead of the other. Further, if an otherwise uninvolved individual were to
attempt to walk in a crouched manner, he or she would experience great fatigue in a short amount of time.
Similarly, if they were to take half steps all day long, they would likewise feel very fatigued. Half steps or a
shorted stride may result from tight hamstrings. Thus, correction of such abnormalities may result in a
more efficient gait, with a greater stride length, greater self selected velocity, and less fatigability.
Because there can be a combination of bony deformity and soft tissue contractures, along with weakness,
deciding how much and which abnormalities to address can at times be challenging. Once a decision to
address a gait aberration has been made, the trend among orthopedic surgeons is to do more at a single
sitting, and, not less. This discussion did not touch on some of the nuiances, such as hyperextension of the
knees, or patella alta, but when severe and symptomatic, these abnormalities may at times require complex
reconstruction as well.