Discrepancies between clinical assessments of lower limb torsional deformities and gait kinematics in ambulatory individuals with cerebral palsy.

BACKGROUND

Cerebral palsy (CP) often presents with lower limb torsional deformities that affect gait and mobility. Clinical assessments typically rely on static physical examinations, but discrepancies arise when compared with dynamic gait kinematics. Understanding the relationship between clinical assessments, including imaging, and gait analysis is essential for accurate diagnosis and treatment planning.

METHODS

This cross-sectional study included 106 limbs from 53 ambulatory individuals with CP, classified as GMFCS levels I to III. Participants underwent standardized physical examinations to assess lower limb rotational deformities, along with three-dimensional CT imaging to quantify skeletal torsion. Instrumented gait analysis measured the foot progression angle (FPA) at angle at initial contact, foot off, and terminal swing. Linear regression analyses examined correlations among these measures, with subgroup analyses by GMFCS level.

RESULTS

Weak correlations were observed between physical examination findings and gait kinematics (R² < 0.5000). Imaging, particularly tibial torsion, showed stronger associations with FPA, especially in GMFCS levels I and III (R² up to 0.9112). GMFCS level II participants showed weaker correlations, suggesting different compensatory mechanisms. Functional severity influenced how static assessments aligned with dynamic gait parameters.

CONCLUSION

While CT remains the gold standard for skeletal torsional deformities, static measurements do not necessarily reflect dynamic gait function. Gait is not solely dictated by skeletal alignment but also shaped by compensatory neuromotor strategies. Integrating gait analysis and imaging into clinical decision-making may improve surgical planning and outcomes, especially when stratified by GMFCS levels.