Toe-walking in children with cerebral palsy: contributions of contracture and excessive contraction of triceps surae muscle.

The study was designed to provide a quantitative analysis of toe-walking in children with cerebral palsy (CP). The total internal moment developed about the ankle joint during locomotion and the passive component of this internal moment were measured. The contributions of the active and passive components were expressed as the ratio (R) between the passive moment and the total internal moment. Measurements were compared for 13 children with CP and 5 healthy children. For the data analysis, the children with CP, exhibiting apparently similar toe-walking, were divided into two groups: 1) Group CPI and 2) Group CPII. Group CPI was characterized by a small ratio R value, which indicated the presence of excessive contractions of the triceps surae muscle during locomotion. In Group CPII, the ratio R value was abnormally high, which indicated that a contracture (ie, structural change of the muscle or the tendon) was entirely or at least partly responsible for toe-walking. Each group requires a different therapeutic strategy.