Cerebral Palsy and Orthopedic Health

Fact Checked

Cerebral palsy is a neurological condition that primarily affects movement. This means that orthopedic health—the health of joints, tendons, bones, and muscles—is affected in children with cerebral palsy. A child with cerebral palsy might have or develop various orthopedic conditions over time, but treatments like physical therapy and surgery can help a child live more comfortably.

Orthopedic Health

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 essential for 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 they grow. 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.

Muscle Contracture

While cerebral palsy cannot be cured and is not progressive, living with orthopedic conditions can be limiting and even painful. Several conditions may affect a child with cerebral palsy, and they can all be treated in some way to improve mobility and 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 usual. This causes them to contract more than is normal, which leads to shortening of the muscles, which affects movement and may cause pain. Physical therapy helps prevent contracture by stretching muscles and improving the range of motion.

Botox is another treatment strategy for contracture.[1] 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

Hip dysplasia is another orthopedic health concern for children with cerebral palsy. It is characterized by a deformity of the hip joint. This often occurs due to either over- or under-toned muscles around the hip that causes 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.[2] 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 to avoid 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 other 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 their toes or the balls of the feet. Physical therapy to stretch the muscles or casts along with Botox and physical therapy can help improve how a child walks.

If these strategies do not help, surgery can be used to release the Achilles tendon.

Scoliosis

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 curvature. Scoliosis appears like a C- or S-shaped curve in the spinal column. Although cerebral palsy itself is not progressive, this condition can worsen 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, making 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.[3] The correction usually improves the gait and ability to walk.

The Importance of Monitoring Orthopedic Health and Using Treatments

Orthopedic health is essential 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 worsen 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, use non-invasive strategies like physical therapy, and 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.