07 Jul Cerebral Palsy and how Podiatrists can help
Cerebral Palsy and how Podiatrists can help
Cerebral palsy (CP) is a term used to describe a group of disorders that affect a persons ability to move. It is due to damage to the developing brain either during pregnancy or shortly after birth. CP is the most common motor disability in childhood.
CP can be quite broad and individual affecting people in many different ways including body movement alteration, altered muscle control and coordination, low muscle tone, altered reflexes, differences in posture and balance.
Depending on which areas of the brain are affected, one or more of the following movement disorders can occur:
- Stiff muscles (spasticity)
- Uncontrollable movements (dyskinesia)
- Poor balance and coordination (ataxia)
Types of CP:
1) Spastic Cerebral Palsy
- The most common type
- Increased muscle tone
2) Spastic diplegia/diparesis – muscle stiffness mainly affecting the legs resulting in difficulty walking. Patients may have tight hip and legs muscles causing their legs to pull together, turn inward and cross over at the knee
3) Spastic Hemeplegia
- Affects one side of the body which is normally their arm and leg
4) Spastic Quadriplegia
- The most severe type of CP affecting arms, legs. trunk and face.
- Usually unable to walk
- Often have other developmental disabilities including seizures, hearing, vision or speach difficulty and intellectual disability.
5) Dyskinetic Cerebral Palsy
- Difficulty controlling hand, arm, feet and leg movements and therefore have difficulty sitting and walking.
- Movements are uncontrolled
- Muscle tone which can alter from day to day – from too tight to too loose
6) Ataxic Cerebral Palsy
- Patients will have balance and coordination problems meaning they are very unsteady when they walk.
- Can have difficulty with writing and other fine motor skills
7) Mixed cerebral palsy
- Some patients may have a mix of more than one type of CP. The most common mixed CP is spastic-dyskinetic CP.
CP is something that is commonly seen by Podiatrists and depending on the type and severity of the patients condition will determine their individual treatment plan.
Common presenting complaints we see as Podiatrists:
- Difficulty trimming own toenails
- Difficulty finding appropriate shoes
- Balance and coordination issues
- Muscle pain and spasms associated with contractures and tight muscles
- Paediatric toe walking
- Muscle fatigue
- Painful callous formation due to altered lower limb mechanics
- Trauma to toenails from altered ground clearance and mechanics which can lead to:
- Increased risk of fungal infections due to opportunistic nature – in particular, candida yeast infections
- Ingrown toenails
- Corns under the nail plate
- Bone bruising or bone growth known as a subungual exostosis – if left untreated can lead to wounds under the nail plate and pain.
- Unable to participate in daily activities as they would like to
Podiatry Treatment and Intervention:
Treatment and intervention is vastly different and individual to each patient and their presenting complaint, goals and disabilty.
- Correct footwear fitting – The Foot Studio has a range of different shoe brands which we measure, order and fit for patients with a range of different depths, widths and sizes.
- Foot orthoses to help with gait abnormalities, balance and proprioception. Foot orthoses may also help with pressure distribution and reduction of painful callous
- Ankle Foot Orthoses (AFO’s) – to help with ground clearance during the swing phase of gait.
- Ankle braces
- Exercise prescription
- Skin and nail care – trimming of toenails, using a gentle electric bur to carefully file the nails reducing edges and pressure, removal of callous and corns using a scalpel. Identifying and treating any fungal or bacterial infections appropriately.
- Referral and working within the allied health multidisciplinary team of the patient