Conditions I treat......... Orthotics in Cerebral Palsy

An orthotic/orthosis is an external support or brace for the limbs or spine and its importance in the Orthopedic Management of cerebral palsy can not be under emphasised. Before embarking on any surgery for a deformity we must first ask the question of whether the same objective can be achieved with an orthotic. An orthotic which obviates the need for surgery will always be vastly more desirable when considering the attendant risks of the latter. However at the same time we have to appreciate that not all deformities can be managed with an orthotic. Often, we may even surgically intervene specifically to facillitate the use of an orthotic.

Orthotics we commonly employ in the orthopedic management of cerebral palsy include:


The UCBL ( University of California Biomechanics Laboratory - you can see why they abbreviated it) orthotic is an excellent insole for improving the biomechanics of a flat foot. The heel cup pushes the heel straight while to augment in the instep reproduces the natural arch of the foot. It also acts as an excellent support in the months following surgical reconstruction of a flat foot.

Leafspring orthosis

A light low profile orthotic which supports the foot to prevent foot drop in children with specific muscle weakness or loss of selective control.

Fixed angle Ankle Foot Orthosis (AFO)

This is the classical work horse orthotic we use for calf muscle tightness in children with cerebral palsy.It's aim is to maintain a plantigrade foot (foot that is flat to the ground) to optimise walking potential and prevent calf muscle tightness pushing the foot towards a tiptoe walking pattern. It can be modified by building up the heel in patients where calf muscle tightness doesn't allow the foot to sit flat. Hinged varieties restricting ankle movement to one direction have theoretical benefits of enabling some motion at the ankle joint. However, I find that this mobility compromises the "constraint" element of the orthotic which is vital to prevent recurrence of deformity.

Ground Reaction Force Orthotic

This is a fixed angle AFO which extends up the front of the shin. This extension effectively pushes back on the shin bone to counter a "crouch" gait pattern where insufficiency of the calf muscles allows the shin bone to drop forwards inappropriately during gait leading to inefficiency of walking and early fatigue. By pushing back on the shin, the GRAFO restores the normal "ankle plantarflexion-knee extension couple." This biomechanical coupling (challenging to explain) is crucial to have an energy efficient walking pattern in children with cerebral palsy where muscles are often weak to begin with.