Date: Tue, 6 Aug 1996 10:42:39 +0800 (WST)
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From: "Sang-Hyun Cho MD." 
To: Multiple recipients of list <[n/a]>
Subject: Reply for the case of 31/7/96
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Hello, this is Dr. Sang-Hyun Cho(MD) at Seoul, S-Korea.
We use Vicon 370 system mostly for cerebral palsy children and 
hemiplegia.   Also, studies about Botox injection effect and new AFO 
effect on gait analysis is under way.

I think the case of 31/7/96 was typical one showing iatrogenically 
developed crouch gait due to overlengthening of Achilles tendon 
lengthening operation.

1. What effect will contact of the knees during 'scissoring' have on the 
inverse dynamics calculation? 
>> Although I do not understand the inverse dynamic calculation as much as biomechanists do, I think the transverse plane plotting for hip 
rotation will be affected most by contact of the  knees during 
scissoring as a sudden errornous bump on the plot.

2. What effect has the previous surgery likely to have had? 
>> Overlengthening of those tendons, then crouch pattern have developed progressively which can be considered as iatrogenic.

3. What further surgery, if any, would you recommend? 
>> First, we should check the passive ROM(range of motion) of her both hip, knee and ankle joins.    If their neutral position can not be 
attained due to joint contracture or tendon tightness, operational 
measure will be required.   I suppose "combined hamstring lengthening 
and transfer" should be considered.   And "intramuscular psoas 
lengthening" if necessary.

Second, as she shows severe scissoring gait and she is already 10 yo, we 
should check both the femoral neck anteversion degree and hip adductor 
spasticity.   Severe femoral neck anteversion will require derotational 
osteotomy and severe hip adductor spasticity can be managed first by 
Botox injection and adductor tenotomy later.

Third, because her both GCM(gastrocnemius) muscle is no loner effective 
both in pulling the tibia backward and in push-off, subtalar arthrodesis 
will be better than AFO which can be some burden for her weak legs.
If the subtalar arthodesis hampers normal push-off, light athletic shoe 
with rocker sole(push-off simulator) will solve the problem.

Well, this is all.
I hope more clinician involved in gait analysis will join this 
discussion and this listserve will be known to more people who are 


Sang-Hyun Cho.
Yonsei Univerisity, College of Medicine, Dept. of PM&R
Seoul, S-KOREA.

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