Atypical Gait and Orthotics CSV Flashcards
What are the prerequisites of normal gait?
The prerequisites of normal gait include:
- Stability in Stance: Stability in stance ensures balance during weight-bearing
- Clearance in Swing: Clearance in swing prevents tripping
- Pre-Positioning of the Foot in Terminal Swing: Pre-positioning allows proper foot placement for the next step
- Adequate Step Length: Adequate step length ensures efficient stride
- Energy Conservation: Energy conservation minimizes fatigue during walking
What are common causes of gait deviations in pediatrics?
Gait deviations can result from:
- impaired motor control
- spasticity
- limited range of motion (ROM)
- decreased strength
- poor sensation
- bony deformities
- These factors disrupt the biomechanical and neuromuscular systems required for normal gait, leading to inefficient or abnormal walking patterns.
What are the three most common causes of in-toeing in pediatrics?
Femoral anteversion:
- Most common in children aged 3–10 years
- Characterized by feet pointing forward and patella turning medially.
- Typically resolves by age 8
Internal Tibial Torsion:
- Common in children aged 1–3 years
- Characterized by patella facing forward while the feet turn inward.
- Typically resolves by age 6
Metatarsus Adductus:
- Found in children under 1 year
- Evolving inward curvature of the foot
- These conditions are developmental and often self-correcting as the musculoskeletal system matures.
What are common characteristics of out-toeing in pediatrics?
Out-toeing can result from:
- External tibial torsion (common in older children or those with spina bifida).
- Planovalgus/Pes Planus (flatfoot): Often seen in early walkers and associated with calcaneal valgus and forefoot abduction.
- Femoral retroversion (common in obese children): Characterized by excessive hip external rotation and decreased hip internal rotation.
- Each condition affects alignment and joint mechanics, potentially increasing the risk of future complications like SCFE or degenerative arthritis.
What is limb length discrepancy (LLD), and what are 5 common causes?
Limb length discrepancy (LLD) occurs when one leg is shorter than the other, caused by
(1) Trauma
- Growth plate injuries
(2) Congenital conditions
- Hemihypertrophy
- Tib/fib hemimelia
- DDH
(3) Neuromuscular disorders
- CP
- Poliomyelitis
(4) Genetic syndromes
(5) Acquired conditions
- SCFE
- Tumors
- Benign bone cysts
- LLD impacts gait symmetry, leading to compensations like toe-walking on the shorter limb or circumduction on the longer limb.
What are compensatory patterns seen with limb length discrepancy?
short vs longer
Shortened Limb:
- Persistent plantarflexion (toe-walking)
- Supination to increase WB through the lateral border of the foot
Longer Limb:
- Circumduction during swing
- Pronation of the foot
- Excessive hip and/or knee flexion to accommodate
- These patterns attempt to equalize leg length during movement but may increase joint stress over time.
How is limb length discrepancy assessed?
Bony Assessment
- True leg length: ASIS to medial malleolus
- Galeazzi sign: femur or tibia
- Calcaneal eversion: Normal: 8 minus age
Muscular Assessment:
- Hip: flexion or adduction limitations
- Knee: Flexion or hyperextension
- Ankle: Limited dorsiflexion, Excessive supination or pronation
- Accurate assessment ensures targeted interventions to minimize compensations and prevent joint issues.
What are the causes, characteristics, and complications of idiopathic toe-walking (ITW)?
Idiopathic Toe-Walking (ITW) or “Bouncy” gait is characterized by:
- Sustained plantarflexion without heel strike, often appearing after age 2 without medical causes.
- Common gait features include
- Absent heel strike: foot flat or contact at metatarsal heads
- Sustained plantar flexion through stance OR hyperextended knees/forefoot pronation to obtain foot flat
- Decreased hip extension and push off at terminal stance
- Long-term ITW can lead to complications like:
- tight plantarflexors
- decreased ROM
- inefficient gait patterns
What treatments are recommended for idiopathic toe-walking?
Treatments include:
- Restore muscle balance (shortened muscles = over recruitment / lengthened muscles = under active)
- motor retraining (balance, functional movements)
- NMES
- orthotics
- stretching (contract-relax)
- serial casting
- strengthening exercises (dorsiflexors, glutes, abdominals)
- These interventions target muscle imbalances, restore normal gait patterns, and prevent long-term complications.
What are common gait deviations in children with cerebral palsy (CP)?
Common deviations include:
- Hemiplegic (weakness or paralysis on one side of the body)
- Equinus (toe-walking with plantarflexion)
- Planovalgus (collapsed arch)
- Crouch gait (excessive hip/knee flexion)
- Jump knee
- Stiff knee gait (limited knee motion during swing)
- These deviations arise from spasticity, muscle imbalances, or bony deformities and impact function and efficiency.
What is equinus gait in children with CP, and how is it treated?
Equinus gait: Abnormal foot position relative to the tibia
- Involves sustained plantarflexion during stance and toe-walking, often with knee hyperextension.
Treatment:
- Hinged or solid AFOs, and exercises targeting gastroc-soleus strengthening and flexibility.
- Interventions reduce spasticity and restore functional alignment during gait.
What are the benefits of orthotics in pediatric gait management?
Orthotics improve function, support development, enhance ROM, provide proprioceptive feedback, and prevent deformity progression.
- By simulating muscle actions or stabilizing joints, orthotics optimize movement patterns and reduce energy expenditure during gait.
What is planovalgus gait, and how does it present in children with CP?
Planovalgus: Equinus of the hindfoot and pronation of the forefoot and midfoot.
- Gastroc-soleus weakness
- Collapse medially (reduce stability and efficiency in gait)
- Unable to push off at terminal stance
- Compensated by:
- Calcaneal/hindfoot valgus, forefoot abduction, and medial arch collapse. It is commonly associated with crouch gait and results from gastroc-soleus weakness and overactive hamstrings.
- PLANOVALGUS/PES PLANUS (flatfoot) - think out-toeing
What is crouch gait, and what are its characteristics?
Crouch gait is characterized by excessive hip flexion, knee flexion, and ankle dorsiflexion.
- It is common in spastic diplegia and quadriplegia
- Short stride length, poor efficiency
- Due to:
- Overactive hamstrings in stance,
- Weak quads
- Weak plantar flexor
- This gait pattern increases energy expenditure and places stress on the joints
- Often requiring orthotic support (Solid ankle AFO or Ground reaction AFO)
What is stiff knee gait, and what causes it in children with CP?
Stiff knee gait is characterized by increased knee extension throughout swing.
- Often caused by overactive rectus
- Compensations:
- Hip circumduction
- Vaulting (plantar flexion with abduction during swing)
- Post pelvic tilt or external rotation to prevent toe drag
- The reduced knee flexion impairs foot clearance and swing efficiency, leading to compensatory strategies like hip circumduction.
What are the characteristics of toe-walking in children with CP?
Toe-walking in CP involves:
- plantarflexion throughout stance
- knee hyperextension in mid-late stance
- possible knee pain in adolescence
- This pattern is often due to spasticity in the gastroc-soleus, resulting in inefficient gait mechanics and increased joint stress.
What is recurvatum gait, and how is it managed?
Recurvatum gait is characterized by knee hyperextension during stance due to gastroc-soleus spasticity or weakness.
Management: AFOs set in 3-5 degrees of dorsiflexion to prevent hyperextension and promote proper alignment.
- Preventing knee hyperextension reduces stress on the posterior knee structures and improves gait mechanics.
Why are orthotics commonly used in pediatric gait management?
- Orthotics address primary impairments like spasticity, weakness, and instability.
- They simulate muscle function, improve alignment, and provide stability during gait.
- By enhancing function and supporting development, orthotics promote mobility and reduce energy expenditure.
What is orthotic tuning, and why is it important?
- Orthotic tuning is the process of fine adjustments to the AFO to optimize its performance in gait.
- It involves analyzing kinematics and kinetics to align the device with the patient’s biomechanics.
- Proper tuning ensures the orthosis meets functional goals, such as stability, efficiency, and comfort.
What are solid ankle AFOs, and when are they used?
Solid ankle AFOs are used for moderate to severe hypertonia, distal stability, and gait control.
- They provide maximum support by restricting ankle motion, improving knee stability, and preventing deformities in children with spasticity or weakness.
What are posterior leaf spring AFOs, and what conditions are they used for?
Posterior leaf spring AFOs assist with dorsiflexion during swing and manage foot drop.
- By allowing some ankle motion, they support mild foot drop while promoting a more natural gait pattern.
What are ground reaction AFOs, and when are they indicated?
Ground reaction AFOs are used for crouch gait, weak quads, or lower-level paraplegia.
They provide stability by controlling knee flexion and improving push-off.
- These AFOs promote energy-efficient gait by leveraging ground reaction forces to support weak muscles.
What are articulating ankle AFOs, and what are their key features?
Articulating AFOs allow controlled ankle motion with adjustable joints for dorsiflexion assist or plantarflexion resistance.
They are used for mild foot drop, genu recurvatum, or moderate medial-lateral instability.
- These orthoses support dynamic movements while maintaining joint stability, improving function in ambulatory children.
What are the benefits of custom orthoses for pediatric patients?
Custom orthoses ensure proper anatomical alignment, accommodate deformities, and meet the unique needs of growing children.
- Customization optimizes fit and function, addressing individual impairments and activity demands while promoting comfort and adherence.
What are the characteristics of hemiplegic gait in children with CP?
Hemiplegic gait presents in progressive patterns:
(1) foot drop during swing with normal plantarflexion;
(2) sustained plantarflexion and knee hyperextension during stance;
(3) limited knee movement in swing; and
(4) hip flexor and adductor tightness reducing hip extension.
- These patterns result from spasticity and weakness, requiring tailored interventions like orthotics and therapy.
