Foot Calluses and Chronic Back Pain in Cerebral Palsy Patients

There is a corn on the inner side of the left big toe, and there is recurrent lower back pain?

I am a patient with cerebral palsy, and I have two questions.
After removing my ankle-foot orthosis for two years, I have developed large calluses on the inner side of the big toe of my left foot (the dominant foot), which have persisted for two years.
I would like to ask the doctor what gait issues this might reflect.
My second question, which has also persisted for two years, is about the severe pain I experience in the lower half of my back.
During orthopedic visits, I often need to receive pain injections.
This pain peaks at certain angles when I stand up from sitting, and it also becomes very painful when I walk with a swaying motion.
Over the past two years, I have experienced about ten episodes of severe pain, each lasting approximately three to four days.
I am unsure what this might indicate.

Wei Wei, 20~29 year old female. Ask Date: 2023/07/01

Dr. Wang Zhaomin reply Rehabilitation

This consultation platform cannot diagnose the abnormal gait of patients with cerebral palsy, which may lead to abnormal wear on the feet, resulting in calluses or pain, and could also cause muscle imbalances in the lower back, leading to strains and premature degeneration of the spine.
These issues may result in discomfort.
Please visit a neurologist, orthopedic specialist, or rehabilitation physician for an accurate diagnosis and to select an appropriate treatment plan.

Reply Date: 2023/07/01

More Info

Cerebral palsy (CP) is a group of disorders that affect movement and muscle tone or posture, caused by damage to the developing brain. Patients with CP often experience a variety of musculoskeletal issues, including gait abnormalities, which can lead to secondary complications such as foot calluses and chronic back pain.
In your case, the presence of large calluses on the inner side of your left big toe (your dominant foot) after removing your ankle-foot orthosis (AFO) could indicate an abnormal gait pattern. Calluses form as a protective response to excessive friction or pressure on the skin. In individuals with CP, gait abnormalities can lead to uneven weight distribution and altered biomechanics, causing certain areas of the foot to bear more weight than others. This can result in callus formation, particularly in areas that are subjected to increased pressure during walking or standing.
The fact that you have been experiencing these calluses for two years suggests that the underlying gait issue has not been addressed. It may be beneficial to consult with a physical therapist who specializes in gait analysis for individuals with CP. They can assess your walking pattern and provide interventions such as orthotic devices, targeted exercises, or modifications to your walking technique to help alleviate the pressure on your foot and reduce callus formation.

Regarding your chronic lower back pain, this is another common issue among individuals with CP. The pain you describe, which intensifies when sitting or standing at certain angles, may be related to muscle imbalances or compensatory movements due to your gait abnormalities. The muscles in your back may be working harder to stabilize your body during movement, leading to fatigue and pain. Additionally, the asymmetrical nature of CP can result in uneven muscle development, which can further contribute to back pain.

It's important to recognize that chronic pain can also lead to a cycle of inactivity, which may exacerbate the problem. Engaging in a tailored rehabilitation program that includes strengthening exercises for your core and back muscles, as well as flexibility training, may help alleviate some of the discomfort. Again, a physical therapist can be instrumental in developing a personalized exercise regimen that addresses your specific needs.

In summary, the calluses on your foot and the chronic back pain you are experiencing are likely interconnected issues stemming from your cerebral palsy and the resulting gait abnormalities. Addressing these concerns through a comprehensive rehabilitation approach that includes gait analysis, physical therapy, and possibly the use of orthotic devices can help improve your overall function and quality of life. It is crucial to work closely with healthcare professionals who understand the complexities of cerebral palsy to ensure you receive the most effective treatment and support.

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