INTRO to paediatric ortho Flashcards
what might concern parents which is part of normal development?
- Bow legs
- Knock- knee
- Intoewing and tripping
- curly toes
- Flexible flat feet
- internal tibial torsion
What are the main causes for intoning and tripping?
- Femoral anteversion 40 degrees at birth. Decreases per annum
- Internal tibial torsion
- Metarsus adduction
Normal gait
Series of rhythmical, alternating movements of the trunk and limbs which result in the forward progression of the centre of gravity
Gait cycle
- Single sequence of function by ONE limb - Begins when reference foot contacts the ground - Ends with subsequent foot contact on the same floor
Stride length
-Distance between successive points of heel contact of the same foot -Double the step length in normal gait
walking base
side to side distance between feet
Cadence
-Number of steps per unit time -Normal 100-115 steps/min
Velocity
- Distance covered by the body in unit time - Usually measure in m/s
Average velocity
-Average velocity (m/min) = step length (m) x cadence (steps/min)
comfortable walking speed
-Least energy consumption per unit distance -Average= 80 m/min (~ 5 km/h , ~ 3 mph)
stages of gait
stance phase swing phase
Stance phase
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’
Swing phase
Reference limb NOT in contact with the floor – 40% of cycle
what forces affect gait?
(1) gravity (2) muscular contraction (3) inertia (4) floor reaction
Gait abnormalities
- Antalgic gait - Lateral Trunk tilt a.k.a. Trendelenberg gait - Functional leg- length discrepancy - increased walking base - Excessive knee extension
Presentation/ causes of antalgic gait
- 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
Presentation of Trendelenberg / aetiology
- Usually unilateral.
- IF bILATERAL= WADDLING GAIT
- Trunk tilts over weakend side
Aetiology
- Painful hip
- Hip abductor weakness
- Leg- length discrepancy
- Abnormal hip joint
Functional leg- length discrepancy compensations?
1- Circumduction 2-Hip hiking 3-Steppage 4- Vaulting
increased walking base gait aetiology
Deformities:
- abducted hip
- valgus knee
Instability
- Cerebellar ataxia
- Proprioception deficit
Presentation of inadequate dorsiflexion control - Aetiology
In stance: Foot slap
In swing : toe drag
Aetiology:
- weak tibias anterior
- spastic plantar flexors
how to identify?
Symptoms – night pain, NWB
Symmetry – lack of it!
Stiffness – of joints, paralysis, Knees = Hips
Syndromes – associated features
Systemic Illness - pyrexia
Knock knee/ bow leg- when would it be abnormal?
