Using high-speed motion pictures, electromyography, a dynamic
piezoelectric force plate, and computer analysis of the data, the gait
patterns of fifteen children, four to sixteen years old, with spastic
cerebral palsy and genu recurvatum were analyzed to determine the
mechanisms producing genu recurvatum and the effect of fixed-ankle
below-the-knee orthoses. In all children the recurvatum during stance phase
began when the tibia stopped moving forward and disappeared when tibial
movement resumed. In six patients (Group I), excessive activity of the calf
muscles in response to the increasing dorsiflexion moment about the ankle
produced by the foot-floor reaction force arrested the forward motion of
the tibia. In six others (Group II), the contraction of the calf muscles
was not sufficiently strong to resist the dorsiflexion moment and the tibia
moved forward until maximum dorsiflexion had occurred and then stopped. In
both instances recurvatum was produced when the femur continued to move
forward over the stationary tibia and an extension moment was produced at
the knee. In no patient did activity of the knee flexors prevent
recurvatum, which was eliminated only by resumption of forward movement of
the tibia. This movement of the tibia was produced either by heel-off
(Group I) or by sudden unweighting of the limb due to opposite heel-strike
(Group II). In Group I, when tibial motion stopped in the first half of
stance phase the position of the hip rapidly changed from flexion to
extension and there was forward leaning of the trunk, while in Group II the
change from hip flexion to extension occurred with backward leaning of the
trunk. The fixed-ankle below-the-knee orthosis, by preventing excessive
dorsiflexion and plantar flexion, produced more normal moments about all
joints, especially the knee. In the three children (Group III) whose
recurvatum was permanently corrected by the brace, no explanation for the
improvement was evident in these studies.