Cerebral palsy (CP) describes a group of disorders that affect a person’s motor function - which means their voluntary, controlled
movements. Symptoms tend to start in early childhood with signs being noticeable as early as 12-18 months old, and it can significantly
affect a person’s mobility and independence throughout their lives. As such, it is a condition that our podiatry team takes very
seriously, working extensively to help support both children and adults in maintaining and improving their gait and overall comfort on their
feet to enhance mobility and independence.
With the cause of cerebral palsy being linked back to some form of brain injury that occurs during pregnancy or infancy, the effects on a
person can vary greatly depending on which specific parts of the brain have been affected, and to what extent. This is why some people
present with severe problems, and others remain mild, though in both cases the symptoms can change over time.
How The Feet Are Impacted By Cerebral Palsy
While the way the feet are affected will depend on which areas of the brain have been affected, there are three common classifications of
Spastic cerebral palsy leads to stiff muscles
Spastic cerebral palsy 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.
Dyskinetic cerebral palsy leads to uncontrollable movements
Dyskinesia is characterised by involuntary muscle movements, whether they are jerky or very slow. This makes walking difficult and
Ataxic cerebral palsy lead to balance and coordination issues
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 cerebral palsy, the severity of these balance and coordination deficits can vary, and if
severe, can make daily movement very difficult.
Common Issues And Symptoms For Cerebral Palsy Sufferers
The symptoms our podiatrists often see in the lower limbs in those with cerebral palsy include:
Hypotonia: hypotonia means having a low muscle tone, which leads to floppy muscles that are less stable, and have been
shown in children to have 52% or less maximum contractile force in the feet and legs compared to same-aged children without cerebral palsy.
Shortened muscles: having a high muscle tone can forcefully contract the muscles, creating significant gait disturbances
from the resulting stiffness and rigidity.
Ankle instability: most commonly occur as a result of low muscle tone which leads to weakness and flexibility, or instead
from high muscle tone that causes stiffness and spasticity.
- Balance and coordination problems, as well as jerky or uncontrolled movements
Toe walking: toe walking is often due to muscle contracture affecting the Achilles tendon that makes bringing the heel in
contact with the ground difficult or uncomfortable.
Unmet milestones: during infancy and childhood, children may not meet typical development milestones, such as rolling,
walking, crawling and sitting.
Clubfoot: clubfoot describes a foot that is significantly twisted inwards and upwards, placing excessive pressure on the
outer border of the foot and causing pain and discomfort.
Foot drop: occurring as a result of muscle weakness or paralysis, foot drop is characterised by
having difficulty lifting the foot at the ankle so that the toes point towards the sky.
Leg length difference: as cerebral palsy can be hemiplegic, meaning that it only affects one side of the body, this can
make one leg longer than the other, which then affects both your gait and the stress that your ankle, knee and hip joints are exposed to.
- Hip dysplasia: hip dysplasia may occur as a result of muscle imbalances that move the hip joint out of alignment.
Flat feet: associated with low muscle tone, having flat feet can also increase the risk of a range of foot problems or
injuries, including plantar fasciitis heel pain and bunions.
High arches: associated with high muscle tone, having high arches mean that the feet don’t have the flexibility or shock
absorption they need to keep you comfortable, stable, or reduce the risk of other injuries.
Claw toes: muscle contracture can also affect the toes, leaving them in a clawed position that can make it difficult to fit
shoes comfortably, and may risk the development of corns, calluses and blisters on the toes.
Treatment For The Feet In Cerebral Palsy
The treatments we recommend to help optimise foot function and comfort in cerebral palsy will depend entirely on the specific way you have
been affected, your symptoms, your concerns and your goals. All of these are covered during your initial assessment with us, where we
complete a thorough clinical exam and get to know your history. From there, we’ll discuss our findings, the possible treatments, and how
they work. This may include:
Surestep SMO: the Surestep supramalleolar orthoses (SMO) is a revolutionary treatment for children with low muscle tone as a
result of cerebral palsy. Together with the right Surestep footwear, it sets children up for success and enables them to have a new level of
mobility and independence.
Custom foot orthotics: orthotics are custom-prescribed shoe inserts that work to either
accommodate the existing structure of a rigid foot and its deformities, offloading high-pressure areas and adding stability and comfort
to the feet, or it can be used as a functional device to support the feet, reduce pain and discomfort, and promote better foot function
and gait in a way that responds to the direct needs of a person’s foot characteristics.
EXO-UP brace: the EXO-UP brace is an innovative brace for foot drop and ankle weakness that is
prescribed and designed following a 3D scan of the foot and ankle. It keeps the foot from catching on the ground, thereby reducing the
risk of falls, while also promoting a better gait pattern
EXO-L brace: the EXO-L brace is also a custom prescribed brace, but is designed specifically for
weak and unstable ankles, and is proven to prevent most ankle sprains.
Mobilisation: foot mobilisation involves the hands-on manipulation of stiff or dysfunctional joints in order to improve
joint alignment, release tension and help your feet and legs function more efficiently.
Skin and nail care: regular skin and nail care appointments can help with any corns, calluses and
nail problems that are produced as a result of the effects of cerebral palsy on the feet
Physical therapy: physical therapy can involve a stretching and strengthening program that is targeted at each person’s
unique symptoms and circumstances, working to optimise the strength and movement in their feet and legs.
Footwear modifications and recommendations: we’re proud to be able to offer a range of footwear
that enable your current shoes to best support you the way your feet require. An example may be adding a rocker bottom sole to help move the
foot efficiently through the step with the help of the rocking motion of the shoe. You can see our full list of modifications here. For mild
cases of cerebral palsy, we can make recommendations on the best shoes for your feet.
MLS laser: MLS laser is a proven, painless and safe treatment that is shown to help improve a
person’s bone density, which is an issue with cerebral palsy. Research has shown improvements in bone mineral density after the use of
laser as well as with their pain, falls risk and health-related quality of life. Additionally, it is also well-known to help with
muscular contractions, thereby having the potential to greatly improve quality of life in those with cerebral palsy.
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