The effect of hinged supracondylar knee ankle foot orthosis on gait parameters in children with spastic cerebral palsy having knee hyperextension and ankle equinus

Ullas Chandra Sahoo, Smrutiprava Sahoo


Background: In cerebral palsy, importance must be given on effective and efficient walking. 30 subjects; 16 males and 14 females (mean age 6.5 year) of spastic cerebral palsy with knee hyperextension and ankle equines were included in this study and were fitted with bilateral moldedhinged SKAFO with pair of shoes.

Methods: Observational gait analysis by video recording was performed and gait parameters by 10 m walk test and knee angle at mid stance using goniometer in standing position were recorded in bracing and non-bracing conditions.

Results: The orthosis controlled knee hyperextension by not restricting normal flexion and extension moment with smooth transition of ankle motion. There was significant improvement in step length; stride length as well as knee angle at midstance (with orthosis) but velocity and cadence were reduced as compared to bare foot walking.

Conclusions: A stable, natural and controlled knee hyperextension gait pattern was found.


Cerebral palsy, Hyperextension, spastic, Supracondylar, Hinged SKAFO

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Sutherland DH, Davids JR. Common gait abnormalities of the knee in cerebral palsy. Clin Orthop Relat Res. 1993;288:139-47.

Simon SR, Deutsch SD, Nuzzo RM, Mansour MJ, Jackson JL, Koskinen M, et al. Genu recurvatum in spastic cerebral palsy. Report on findings by gait analysis. J Bone Joint Surg Am. 1978;60:882-94.

Becher JG. Pediatric rehabilitation in children with cerebral palsy: General management, classification of motor disorders. J Prosthet Orthot. 2002;14:143-9.

Morris C. Orthotic management of children with cerebral palsy. J Prosthet Orthot. 2002;14:150-8.

Gugenheim JJ, Rosenthal RK, Simon SR. Knee flexion deformities and genu recurvatum in cerebral palsy: roentgenographic findings. Dev Med Child Neurol. 1979;21:563-70.

Morris ME, Matyas TA, Bach TM, Goldie PA. Electrogoniometric feedback: its effect on genu recurvatum in stroke. Arch Phys Med Rehabil. 1992; 73:1147-54.

Dhawlikar SH, Root L, Mann RL. Distal lengthening of the hamstrings in patients who have cerebral palsy. Long-term retrospective analysis. J Bone Joint Surg Am. 1992;74:1385-91.

Perry J, Antonelli D, Ford W. Analysis of knee-joint forces during flexed-knee stance. J Bone Joint Surg Am. 1975;57:961-7.

Kerrigan DC, Deming LC, Holden MK. Knee recurvatum in gait: a study of associated knee biomechanics. Arch Phys Med Rehabil. 1996;77:645-50.

Hullin MG, Robb JE, Loudon IR. Gait patterns in children with hemiplegic spastic cerebral palsy. J Pediatr Orthop B. 1996;5:247-51.

Middleton EA, Hurley GR, McIlwain JS. The role of rigid and hinged polypropylene ankle-foot-orthoses in the management of cerebral palsy: a case study. Prosthet Orthot Int. 1988;12(3):129-35.

Im HY. The immediate effect standing balance and dynamic activity on barefoot, wearing SPAFO and wearing HPAFO in hemiplegic patients. J Kor Phys Ther. 2005;17(1):87-97.

Radtka SA, Skinner SR, Johanson ME. A comparison of gait with solid and hinged ankle-foot orthoses in children with spastic diplegic cerebral palsy. Gait Posture. 2005;21(3):303-10.

Fish DJ, Kosta CS. Genu recurvatum: Identification of three distinct mechanical profiles. J Prosthet Orthot.1998;10:226-32.

Klotz MC et al. The association of equinus and primary genu recurvatum gait in cerebral palsy. Res Dev Disabil. 2014;35:1357-63.

Thompson P, Beath T, Bell J, Jacobson G, Phair T, Salbach NM, et al. Test-retest reliability of the 10-metre fast walk test and 6- minute walk test in ambulatory school-aged children with cerebral palsy. Dev Med Child Neurol. 2008;50:370-6.

Rosenthal RK, Deutsch SD, Miller W, Schumann W, Hall JE. A fixed-ankle, below-the-knee orthosis for the management of genu recurvation in spastic cerebral palsy. J Bone Joint Surg Am. 1975;57:545-7.

Buckon CE, Thomas SS, Jakobson-Huston S, Sussman M, Aiona M. Comparison of three ankle-foot orthosis configurations for children with spastic hemiplegia. Dev Med Child Neurol. 2001;43:371-8.

Crenshaw S, Herzog R, Castagno P, Richards J, Miller F, Michaloski G, et al. The efficacy of tone-reducing features in orthotics on the gait of children with spastic diplegic cerebral palsy. J Pediatr Orthop. 2000;20:210-6.

Mohanty A. Efficacy of supracondylar knee ankle foot orthosis for hyperextended knee and heel rise in spastic cerebral palsy: A pilot clinical trial. Indian J Cerebral Palsy. 2016;2:22.

Figueiredo EM, Ferreira GB, Maia Moreira RC, Kirkwood RN, Fetters L. Efficacy of ankle-foot orthoses on gait of children with cerebral palsy: Systematic review of literature. Pediatr Phys Ther. 2008;20:207-23.