Problem: Muscular imbalance in cerebral palsy can result from muscular weakness, contracture & Lever arm problem. Lever arm problem arise due to bony torsion, short lever arm length & joint dislocation. Usual bony torsion in cerebral palsy is internal femoral torsion, external tibial torsion & planovalgus feet. All these bony torsion cause insufficiency of muscle and causes various gait abnormalities.
Management Protocol: It is very important to include correction of all bony torsion during single event surgical intervention. Femoral & tibial torsion can be corrected by doing bony derotation osteotomy & planovalgus feet need bony surgery in feet.