Table 4 Relationship between pathological gait types and primary management methods applied

Drop foot

Drop foot during swing due to inability to control ankle dorsiflexors. No calf contracture, so during stance, dorsiflexion is normal. Lack of first rocker

Rare. Normally it progresses to others more severe

HAFO or PLS-AFO

Not applicable

True equinus (w/o knee recurvatum)

True equinus during stance due to spasticity or contracture of the gastroc-soleus muscles. Drop foot in swing for impaired function in ankle dorsiflexors

Very common

HAFO or PLS-AFO

BTX-A to calf, Tendo Achilles and/or calf lengthening

Jump gait (w/o stiff knee)

Spasticity on hamstrings and hip flexors in addition to calf spasticity/contracture. The ankle is in equinus, with knee and hip in flexion and anterior pelvis tilt

Very common

HAFO, PLS-AFO or SAFO

BTX-A to calf and hamstrings. SEMLS for addressing lever arm dysfunction

Apparent equinus (w/o stiff knee)

Progression of pathological gait with child’s growth. Ankle has an apparent normal dorsiflexion during stance, but knee and hip are in excessive flexion.

Common

PLS-AFO, SAFO or GRAFO

No BTX-A to the calf, as it would cause crouch gait. SEMLS for addressing lever arm dysfunction

Crouch gait

Excessive ankle dorsiflexion during stance in combination with excessive knee and hip flexion.

Only severe cases

GRAFO

The pathology is normally too advanced to use BTX-A, although if the child is young, BTX-A can be used on HAMS and hip flexors. SEMLS for addressing lever arm dysfunction