Spastic Diplegia Gait Patterns: Rodda Classification, Equinus and AFO Selection
In short
Spastic diplegia produces distinct sagittal gait abnormalities. Learn the Rodda classification, understand why isolated Achilles lengthening is dangerous, and select proper AFOs.
In this guide (4 sections)
Understanding Gait in Spastic Diplegia
Spastic diplegia, the most common form of cerebral palsy, predominantly involves bilateral lower extremities with variable trunk involvement. Damage to the periventricular white matter (periventricular leukomalacia) impairs corticospinal tract control.
In 2001, Graham and Rodda classified spastic diplegia gait into four distinct sagittal plane patterns based on video motion analysis. Correctly identifying the pattern prevents devastating surgical errors, such as over-lengthening the Achilles tendon.
The 4 Rodda Sagittal Gait Patterns
Each pattern reflects progressive multi-level muscular involvement advancing from distal calf spasticity to proximal hip and knee flexion contractures.
| Gait Pattern | Ankle Position | Knee Position | Hip Position | Primary Muscular Pathology | |
|---|---|---|---|---|---|
| Group 1: True Equinus | Plantarflexion in stance and swing | Full extension or recurvatum | Neutral or slight flexion | Isolated spasticity of gastrocnemius-soleus. | |
| Group 2: Jump Gait | True equinus (heel off floor) | Excessive flexion in early stance, extension in late stance | Excessive flexion and anterior pelvic tilt | Spastic calf, hamstrings and hip flexors. | |
| Group 3: Apparent Equinus | Neutral dorsiflexion (looks like equinus due to knee flexion) | Excessive flexion throughout stance | Excessive flexion and anterior tilt | Hamstring and hip flexor contracture; calf normal or weak. | |
| Group 4: Crouch Gait | Excessive dorsiflexion (calcaneus gait) | Severe flexion throughout stance (>30 degrees) | Severe flexion, posterior pelvic tilt | Severe calf weakness (often post-surgery); tight hamstrings/psoas. |
AFO Orthotic Prescription Guidelines
Ankle-Foot Orthoses (AFOs) must be selected according to the exact Rodda gait group to optimize ground reaction forces and prevent progressive crouch deformity.
- Solid AFO (SAFO): Indicated for Group 1 True Equinus and severe mediolateral ankle instability. Blocks all ankle motion to establish a stable base and promote heel strike.
- Hinged AFO (HAFO): Indicated for Group 2 Jump Gait where passive ankle dorsiflexion reaches at least 5 degrees. Permits free forward tibial progression while blocking plantarflexion.
- Ground Reaction AFO (GRAFO): Indicated for Group 3 Apparent Equinus and early Group 4 Crouch Gait. Features a rigid anterior pretibial shell that applies a backward extension moment to the knee during mid-to-late stance.
- The Danger of Heel Cord Lengthening in Group 3: If a child in Apparent Equinus undergoes Achilles tendon lengthening, the calf muscle is weakened. The tibia collapses forward into severe crouch gait, which is exceptionally difficult to correct.
Frequently Asked Questions
How many hours a day should a child wear their AFOs?
AFOs are worn during all daytime weight-bearing and ambulatory hours (typically 8 to 12 hours daily). They are removed for bathing, skin checks, and active floor physiotherapy.
Can partial body-weight supported treadmill training help spastic diplegia?
Yes. Body-weight supported treadmill training (PBWSTT) unloads 20 to 40 percent of body weight, allowing children to practice reciprocal stepping with normalized hip and knee kinematics.
What is the minimum quadriceps strength needed for a GRAFO to work?
The child must possess at least Grade 3 (fair) quadriceps strength. If quadriceps strength is insufficient, the knee collapses into flexion despite the anterior brace shell.
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