Paediatric orthopaedics: crouch gait after Achilles lengthening: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Paediatric orthopaedics: crouch gait after Achilles lengthening

Sample item

A 14-year-old with spastic diplegia had Achilles tendon lengthening at age 8. He now walks with excessive ankle dorsiflexion and excessive knee and hip flexion in stance. Which gait pattern and likely cause does this represent?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Crouch gait after over-lengthening of the Achilles tendon

Crouch gait combines excessive dorsiflexion with knee and hip flexion in stance. Over-lengthening of the triceps surae removes the plantarflexion-knee extension couple, so the knee collapses into flexion. This is why isolated Achilles lengthening is avoided in spastic diplegia and gastrocnemius recession or botulinum toxin is preferred for equinus.

Option by option

  • A. Crouch gait after over-lengthening of the Achilles tendon (correct)

    Correct. Weakened plantarflexion after over-lengthening leads to crouching.

  • B. Recurvatum gait from quadriceps weakness

    Recurvatum shows hyperextension of the knee, the opposite pattern.

  • C. Stiff-knee gait from rectus femoris spasticity

    Stiff-knee gait shows reduced knee flexion in swing.

  • D. Jump gait from untreated hamstring spasticity

    Jump gait has equinus with flexed knee and hip, not excess dorsiflexion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, Crouch gait after over-lengthening of the Achilles tendon. Crouch gait combines excessive dorsiflexion with knee and hip flexion in stance.

Why is "Recurvatum gait from quadriceps weakness" not the answer?

Recurvatum shows hyperextension of the knee, the opposite pattern.

Why is "Stiff-knee gait from rectus femoris spasticity" not the answer?

Stiff-knee gait shows reduced knee flexion in swing.

Why is "Jump gait from untreated hamstring spasticity" not the answer?

Jump gait has equinus with flexed knee and hip, not excess dorsiflexion.

What concept does this question test?

It tests Paediatric orthopaedics: crouch gait after Achilles lengthening in Orthopaedics. Over-lengthening of the triceps surae removes the plantarflexion-knee extension couple, so the knee collapses into flexion. This is why isolated Achilles lengthening is avoided in spastic diplegia and gastrocnemius recession or botulinum toxin is preferred for equinus.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric orthopaedics: crouch gait after Achilles lengthening?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.