INTRO to paediatric ortho

Question 1

what might concern parents which is part of normal development?

Answer 1

• Bow legs
• Knock- knee
• Intoewing and tripping
• curly toes
• Flexible flat feet
• internal tibial torsion

Question 2

What are the main causes for intoning and tripping?

Answer 2

• Femoral anteversion 40 degrees at birth. Decreases per annum
• Internal tibial torsion
• Metarsus adduction

Question 3

Normal gait

Answer 3

Series of rhythmical, alternating movements of the trunk and limbs which result in the forward progression of the centre of gravity

Question 4

Gait cycle

Answer 4

• Single sequence of function by ONE limb - Begins when reference foot contacts the ground - Ends with subsequent foot contact on the same floor

Question 5

Stride length

Answer 5

-Distance between successive points of heel contact of the same foot -Double the step length in normal gait

Question 6

walking base

Answer 6

side to side distance between feet

Question 7

Cadence

Answer 7

-Number of steps per unit time -Normal 100-115 steps/min

Question 8

Velocity

Answer 8

• Distance covered by the body in unit time - Usually measure in m/s

Question 9

Average velocity

Answer 9

-Average velocity (m/min) = step length (m) x cadence (steps/min)

Question 10

comfortable walking speed

Answer 10

-Least energy consumption per unit distance -Average= 80 m/min (~ 5 km/h , ~ 3 mph)

Question 11

stages of gait

Answer 11

stance phase swing phase

Question 12

Stance phase

Answer 12

Reference limb in contact with the floor – 60% of cycle

• Heel contact: ‘Initial contact’- when one foot reaches the ground
• Foot-flat: ‘Loading response’, initial contact of forefoot w. ground
• Midstance: greater trochanter in alignment w. vertical bisector of foot
• Heel-off of opposite foot- ‘Terminal stance’
• Toe-off: ‘Pre-swing’

Question 13

Swing phase

Answer 13

Reference limb NOT in contact with the floor – 40% of cycle

Question 14

what forces affect gait?

Answer 14

(1) gravity (2) muscular contraction (3) inertia (4) floor reaction

Question 15

Gait abnormalities

Answer 15

• Antalgic gait - Lateral Trunk tilt a.k.a. Trendelenberg gait - Functional leg- length discrepancy - increased walking base - Excessive knee extension

Question 16

Presentation/ causes of antalgic gait

Answer 16

• Stance phase on affected side is shortened due to pain - increased stance on opposite side - Quick and short steps on affected side - Common causes: Splinter in foot, OA, Tendinitis

Question 17

Presentation of Trendelenberg / aetiology

Answer 17

• Usually unilateral.
• IF bILATERAL= WADDLING GAIT
• Trunk tilts over weakend side

Aetiology

• Painful hip
• Hip abductor weakness
• Leg- length discrepancy
• Abnormal hip joint

Question 18

Functional leg- length discrepancy compensations?

Answer 18

1- Circumduction 2-Hip hiking 3-Steppage 4- Vaulting

Question 19

increased walking base gait aetiology

Answer 19

Deformities:

• abducted hip
• valgus knee

Instability

• Cerebellar ataxia
• Proprioception deficit

Question 20

Presentation of inadequate dorsiflexion control - Aetiology

Answer 20

In stance: Foot slap

In swing : toe drag

Aetiology:

• weak tibias anterior
• spastic plantar flexors

Question 21

how to identify?

Answer 21

Symptoms – night pain, NWB

Symmetry – lack of it!

Stiffness – of joints, paralysis, Knees = Hips

Syndromes – associated features

Systemic Illness - pyrexia

Question 22

Knock knee/ bow leg- when would it be abnormal?

Answer 22