Gastrocnemius and soleus lengths in cerebral palsy equinus gait—differences between children with and without static contracture and effects of gastrocnemius recession

Equinus gait is one of the most common abnormalities in children with cerebral palsy. Although it is generally assumed that the calf muscles are abnormally short in equinus gait, no studies have been done to confirm that the muscles are short and that this shortness contributes to the equinus. This study used musculoskeletal modeling combined with computerized gait analysis to examine medial gastrocnemius (MGAS), lateral gastrocnemius (LGAS), and soleus (SOL) musculotendinous lengths during equinus gait in children with cerebral palsy. All three muscles were abnormally short during equinus gait whether or not the children had equinus contractures (P 0.005). Children with static contractures had shorter maximum static MGAS and LGAS lengths than children with dynamic equinus (P 0.002). The children with static contractures had ratios of peak dynamic length to maximum static length close to 1.0 for MGAS and LGAS (1.005±0.015) but lower ratios for SOL (0.984±0.024). For the children with static contracture, these ratios did not change significantly after gastrocnemius recession (P 0.14) because both static and dynamic lengths increased postoperatively (P 0.04). These results support the current clinical understanding of the role of calf “tightness” in equinus gait, including the appropriateness and effectiveness of gastrocnemius recession for children with equinus contracture.