Pediatric Orthopedic Surgeons treating a Broken Wrist

DIPLEGIC GAIT

Diplegia refers to symmetrical paralysis, usually affecting either the arms or the legs. It’s the most common cause of paralysis in children and causes a different way of walking called Diplegic Gate.

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Diplegic Gait

Patients with Diplegic Gait experience spasticity on both sides of their bodies. In addition, their lower extremity spasticity appears more severe than their upper extremity spasticity. The patients drag both legs and scrape their toes when walking with an excessively narrow base. Bilateral periventricular lesions, like those observed in cerebral palsy, are associated with this gait. A scissors gait, caused by the excessive tightness of the hip muscles, is another recognizable trait. Patients with cerebral palsy may have hip muscle release surgery with competent medical care to reduce scissoring. This procedure takes experience and a high degree of expertise.  We have that expertise.

Children with cerebral palsy (CP) have a wide range of paralysis involvement. Paralysis can range from one single part to quadriplegic and hemiplegic at the more severe end. Due in large part to the variety and blending of children with paralysis, it is difficult to create severity groupings.  There are undoubtedly kids with mild to severe paralysis, but both populations appear at the extremes of a normal distribution curve with the mean being moderate involvement but still very serious.

The severity of the underlying condition often gets worse as the paralysis gets worse — from involving fingers and toes to paralysis of arms and legs. Rarely do we see children with minor paralysis.  For example, it is usually hip, knee, and ankle involvement. The age of the children, rather than the individual severity, is used to implement treatment.

Treatment of Diplegic Gait

Physical therapy and orthotics are typically used to treat young children under the age of five who experience significant spasticity. Botulinum toxin injections provide treatment as well. At this point, doctors should think about the possibility of reducing general spasticity with intrathecal baclofen or dorsal rhizotomy.

Finally, treatment of a Diplegic Gait should concentrate on resolving toe walking, flexed knee gait, and severe lower extremity torsional deformities for children between 5 and 10. Also, at this age, muscle lengthening and, on occasion, the correction of torsional malalignments by surgical procedures provide doctors with additional treatments that can improve patients well being.  The phase between adolescence and growing maturity — between the ages of 10 and 16 — appears as the best time for final deformity adjustments to be made. Specifically, we are referring to foot stability, further muscle lengthening, and bone alignment correction.

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