Lower limb deformity and prevention of scoliosis in cerebral palsy.

Sustained motor delay, muscle imbalance, or restricted movement precede the musculoskeletal deformities which complicate many neuromuscular disorders. Infantile alignments, anteversion of the femoral necks, torsion of the tibia and coxa valga are retained,' and infantile postural asymmetry induces a structural asymmetry which lasts several years in normal children,2 but persists as scoliosis, pelvic tilting, windswept deformity, and hip dislocation in those with neuromuscular disorders.3 Spasticity and muscular hypotonia can coexist:4 in the former muscle imbalance produces shortening, or contracture of the stronger muscles, elongation of the weaker muscles, and restricted joint movement. Hypotonia causes lax joints and flat feet. Contractures seldom occur without hypertonia, and seldom present in the 11% of 'clumsy' children who have a previously unrecognised mild cerebral palsy5 but are common in quadriplegics, with neurological signs and additional handicaps.6 For those who teach themselves to stand before the age of 3 the prospects for walking unaided are good,7 and only about 25% of the spastic and rigid contractures in this group require surgery,8 usually of the calf and hip adductors.