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Cerebral palsy is a neurological condition that mostly affects movement. This means that orthopedic health—the health of joints, tendons, bones, and muscles—is affected in children with cerebral palsy. While the movement is always affected to some degree in a child with this condition, the degree to which orthopedic health is impacted, and in what way, varies by individual.
There are several orthopedic conditions that a child with cerebral palsy may have or develop over time, including those that affect fine and gross motor function, balance, muscle tone, oral motor function, posture, coordination, and reflexes.
There are also many treatment strategies, from physical therapy to surgery, that can help a child live more comfortably with these conditions and see improvement in symptoms and complications.
Orthopedics refers to anything related to the musculoskeletal system: the connection of bones, muscles, tendons, ligaments, and joints. It is the system of the body that allows us to move. When something goes wrong with it, the result may be limited movement, awkward movements, or pain.
Orthopedic surgeons are important as part of an overall cerebral palsy medical team and life care plan.
An orthopedic specialist can diagnose conditions in a child with cerebral palsy and determine the severity and how that condition will affect the child as he or she grows. This specialist can also recommend and administer treatment, including surgeries to help correct damage or improve movement.
An orthopedist can also help parents learn how to prevent injuries or a worsening of any conditions related to the musculoskeletal system.
While cerebral palsy cannot be cured and is not progressive, living with orthopedic conditions can be limiting and even painful. There are several conditions that may affect a child with cerebral palsy, and they can all be treated in some way to improve mobility and to reduce pain.
One of the most common orthopedic health consequences is muscle contracture caused by overly-toned muscles.
Many children with cerebral palsy have muscles that are more toned than normal. This causes them to contract more than is normal, which in turn leads to shortening of the muscles, which affects movement and may cause pain. Physical therapy helps to prevent contracture by stretching muscles and improving range of motion.
Botox is another treatment strategy for contracture.  This toxin can be injected into a contracted muscle to allow it to stretch and relax. The effects last for a few months and the injection is typically used along with physical therapy.
When these treatments don’t help, a child may have surgery to release tendons. This allows the muscles to stretch more.
Hip dysplasia is another orthopedic health concern for children with cerebral palsy and it is characterized by a deformity of the hip joint. This often occurs as a result of either over- or under-toned muscles around the hip that cause the joints to become misaligned.
Hip dysplasia can be treated with surgery that realigns the hip joint and keeps the top of the femur in place in the joint.  Physical therapy may also help prevent dysplasia by working on the tone of the muscles surrounding the joint. Therapy may also help a child move in a way that prevents further damage to the joint.
Foot Orthopedic Health
Abnormal contractions of muscles in the feet of a child with cerebral palsy can lead to a flat foot, with no arch or a very low arch. This is most common when cerebral palsy causes the muscles in the foot to have a low tone.
A child may also develop what is called equinovarus, more commonly known as clubfoot. With this deformity, the foot twists upward and makes walking and any other types of weight-bearing activity difficult. Flat foot is most often treated with a simple orthotic insert, while clubfoot is typically treated with surgery and casting.
When the tone of muscles in the ankles is too high, a child may develop toe walking. The contracture of the muscles makes a child walk on his or her toes or on the balls of the feet. Physical therapy to stretch the muscles or casts along with Botox and physical therapy can help improve the way in which a child walks.
If these strategies do not help, surgery can be used to release the Achilles tendon.
Cerebral palsy may cause a child to develop scoliosis, the curvature of the spine. The muscles of the back affected by cerebral palsy are not adequate to support the spine, and this causes the curvature. Scoliosis appears like a C- or S-shaped curve in the spinal column. Although cerebral palsy itself is not progressive, this is a condition that can get worse with time if not treated.
A back brace is a common treatment. It supports the spine when the muscles cannot and encourage normal growth. When the curvature is severe or is impairing a child to a severe degree, surgery may be used to insert a metal rod that straightens the spine.
Other Orthopedic Health Concerns
A child with cerebral palsy may have one leg longer than the other, to a degree that makes walking difficult or uncomfortable. Surgery can be used to shorten the longer leg, but this is usually only done when the difference is more than two centimeters. Otherwise, a lift in the shoe is typically adequate to improve mobility and comfort.
Torsion in the legs is another possible issue. This occurs when the legs either twist in or out, and it can make walking difficult. A surgical procedure can be used to cut the affected bone, usually the femur or tibia, and reposition it with surgical pins and plates.  The correction usually improves the gait and ability to walk.
The Importance of Monitoring Orthopedic Health and Using Treatments
Orthopedic health is important because it affects how a child moves. When orthopedic health is compromised, a child may be limited in mobility and may even be in pain or discomfort. Cerebral palsy does not get worse with time, but the abnormalities it causes in muscles can cause orthopedic conditions. These can get worse with time if not addressed and treated.
To give a child with cerebral palsy the best opportunity for a full life, it is crucial to monitor orthopedic health, to use non-invasive strategies like physical therapy, and to resort to surgery as needed.
Ongoing physical therapy is especially important, as it helps joints and bones stay in the correct alignment and can prevent problems or keep them from getting worse. If you have a child with cerebral palsy, be sure an orthopedic specialist is part of the medical team.
- Botulinum toxin and burn induces contracture. (n.d.). PubMed Central (PMC). National Institutes of Health.
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122557/
- Hip dysplasia - Diagnosis and treatment. (2020, March 20). Mayo Clinic - Mayo Clinic.
Retrieved from: https://www.mayoclinic.org/diseases-conditions/hip-dysplasia/diagnosis-treatment/drc-20350214
- Tibial De-Rotational Osteotomies for Tibial Torsion. (n.d.). Children's Health Care | Nemours Children's Health System.
Retrieved from: https://www.nemours.org/content/dam/nemours/wwwv2/filebox/service/medical/Cerebral%20Palsy/Tibial-De-rotational-Osteotomies-for-Tibial-Torsion-FINAL.pdf