Importance of orthotic subtalar alignment for development and gait of children with cerebral palsy.

PURPOSE: This case report addresses the assumption that ankle and foot orthoses assist children with cerebral palsy.

KEY POINTS: Outcome research reports are not consistent. Clinical observations and research studies suggest that inappropriate fit and design of orthoses may contribute to poor outcomes. In particular, problems occur when the subtalar joint is out of alignment as children often compensate with unwanted movement patterns that affect progress, development, and function. Four cases are presented to demonstrate problems that can occur when ankle-foot or supramalleolar orthoses are not cast in subtalar neutral.

CONCLUSION: Physical therapists can use their clinical observation skills to evaluate the proper fit and alignment of orthoses for children with cerebral palsy.