Podiatry

This page covers:
– What is the problem? – musculosketal, cardivascular and respiratory systems
– Podiatric interventions
– Conclusion

What is the problem?

“People with CP often experience complications with their feet and lower limbs, such as gait anomalies due to muscle spasticity, poor balance, and foot deformities. Podiatrists can help manage these issues through assessment, treatment, and advice on a wide range of issues to prevent further complications”
Royal College of Podiatry 2023

Musculoskeletal System

Individuals with CP often experience muscle weakness, spasticity, and contractures, which can lead to tissue damage and pain. Common issues include:

• Muscle Weakness and Spasticity: Leading to difficulty in movement and increased pain.
• Contractures: Permanent tightening of muscles and tendons.
• Joint Deformities: Such as hip dislocation, scoliosis, and foot deformities, often beginning in childhood.

Cardiovascular System

Adults with CP may be at increased risk of cardiovascular disease due to decreased physical activity and a sedentary lifestyle. Key issues include:

• Increased Cardiovascular Risk: Due to limited mobility and activity.
• Abnormal Heart Rhythms: Such as atrial fibrillation.
• Hypertension: Leading to potential damage to the heart and blood vessels.

Respiratory System

Impaired lung function is another concern for adults with CP, often resulting from weak respiratory muscles and conditions like scoliosis. This can lead to:

• Reduced Lung Function: Due to weak respiratory muscles.
• Increased Risk of Infections: Frequent respiratory infections can occur.
• Tissue Damage: Long-term lung damage from recurrent infections.

How do we manage it?

Podiatric Interventions

Podiatrists play a critical role in managing the foot and lower limb complications in individuals with CP. Common interventions include:

• Orthoses: Pre-fabricated or custom-made to improve foot function and reduce pressure.
• Strengthening Exercises: To maintain muscle function and mobility.
• Footwear Modifications: To accommodate braces, AFOs, or other assistive devices.
• Pressure Redistribution: Techniques to improve tissue viability.
• Nail and Skin Care: Preventing infections and other complications.
• Gait Analysis and Training: Improving walking patterns to reduce pain and fall risk.

Addressing Ankle Instability

Ankle instability is a common problem, influenced by:

• Muscle Tone Variations: Low muscle tone causing weakness and increased flexibility, or high muscle tone causing stiffness and spasticity.
• Gait Complications: Reduced ankle dorsiflexion during gait leading to compensatory movements.

Footwear and Modifications

Appropriate footwear is crucial for support and stability. Podiatrists can provide:

• Bespoke Therapeutic Footwear: Tailored to individual needs.
• Footwear Advice: For selecting suitable everyday footwear from general retail.

Tissue Integrity

Both children and adults with CP may experience tissue damage due to increased oxidative stress and inflammation. Podiatrists help in:

• Reducing Pressure Ulceration Risk: Using expertise to maintain tissue health.
• Managing Oxidative Stress: Understanding higher levels of oxidative stress markers in individuals with CP.

Conclusion

Effective management of CP in adults requires a comprehensive approach addressing musculoskeletal, cardiovascular, and respiratory complications. Podiatrists play a vital role in providing interventions that enhance mobility, reduce pain, and improve overall quality of life. Through tailored care and appropriate interventions, individuals with CP can achieve better health outcomes and maintain independence.

For more information please contact The Royal college of podiatry https://rcpod.org.uk/

“By addressing foot and lower limb issues, podiatry can help improve mobility, reduce pain, and enhance the overall quality of life for people with CP.”
Podiatry’s role in managing children and adults with Cerebral Palsy – Royal College of Podiatry – position paper 2023