Changes in the Gastrocnemius and Soleus Muscle Length during Gait in CP Patients with an Equinus Deformity

Hayong Kim; Jae Hoon Ahn; Hang Ho Lee; Jea Yun Koo; Han Cherl Yee; Won Sik Choy

doi:10.4055/jkoa.2009.44.2.170

Journal List > J Korean Orthop Assoc > v.44(2) > 1012885

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Kim, Ahn, Lee, Koo, Yee, and Choy: Changes in the Gastrocnemius and Soleus Muscle Length during Gait in CP Patients with an Equinus Deformity

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(2): 170-179.

Published online: 30 April 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.2.170

Changes in the Gastrocnemius and Soleus Muscle Length during Gait in CP Patients with an Equinus Deformity

Hayong Kim, M.D., Jae Hoon Ahn, M.D., Hang Ho Lee, M.D.^*, Jea Yun Koo, M.D., Han Cherl Yee, Ph.D., Won Sik Choy, M.D.

Department of Orthopaedic Surgery, Eulji University College of Medicine, Daejeon, Korea.

^*Hongseong Medical Center, Hongseong, Korea.

Address reprint requests to Jae Hoon Ahn, M.D. Department of Orthopaedic Surgery, Eulji University College of Medicine, 1306, Dunsan-dong, Seo-gu, Daejeon 302-799, Korea. Tel: +82.42-611-3268, Fax: +82.42-259-1289, hykim@eulji.ac.kr

Abstract

Purpose

To measure the muscle length of the gastrocnemius and soleus during gait in CP patients with an equinus deformity before and after surgery.

Materials and Methods

Twelve CP patients with an equinus deformity (17 limbs) were examined by gait analysis preoperatively and postoperatively. The patient group was further classified into the TAL and Strayer group according to the surgical technique. The mean age and mean follow-up periods were 14.3 years (5-25 years) and 15.3 months (12.5-18.5 months), respectively. The muscle length of the Gastrocnemius and Soleus was measured during gait using the SIMM program linked to a gait analysis system.

Results

The ankle ROM, knee ROM, maximal muscle length and peak-to-peak excursion during gait improved after surgery. There was a significant difference between the preoperative and postoperative measurements (p<0.05), but no difference between the postoperative and control groups (p>0.05). The muscle length of the soleus was elongated during gait after the Strayer procedure.

Conclusion

Patients with an equinus deformity had a contracted triceps muscle, which was elongated after surgery. These changes were quantified by a comparison of the preoperative and postoperative measurements.

Keywords: Cerebral palsy, Equinus deformity, TAL, Strayer, Gait analysis

Figures and Tables

Fig. 1

Muscle modeling using SIMM. Muscle model was made for the lateral head of gastrocnemius (LGAS), medial head of gastrocnemius (MGAS), and soleus (SOL). The changes of muscle lengths during gait were measured with these muscle models.

Fig. 2

Ankle and knee kinematic curve and points (a1-a5) at which the muscle length was measured.

Fig. 3

The changes of ankle and knee kinematics after the operation in Strayer and TAL group.

Fig. 4

The changes of muscle length during gait in control group.

Fig. 5

The changes of muscle length during gait in patient group at preoperative and postoperative gait analysis.

Fig. 6

Schematic relationships of gastrocnemius and soleus muscle after Strayer procedure.

Table 1

Patient Data Profiles

M, male; F, female; Rt, right; Lt, left; TAL, Z-plasty tendo-achilles lengthening.

Table 2

Associated Procedures

Table 3

Results of Mean Muscle Length and Ankle Joint Kinematics of Control and Patient Group

a1, anle joint at IC (initial contact); a3, ankle at the end of second rocker (Lmax); a4, ankle at the end of third rocker (Lmin); a5, ankle at its maximum dorsiflexion during swing phase; MGAS, medial head of gastrocnemius; LGAS, lateral head of gastrocnemius; SOL, soleus.

Table 4

Normalization Values of Muscle Length Changes

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