Normal Variants Gait

Question 1

Red Flags

Answer 1

asymmetry 
no independent gait by 18 mths 
worsening presentation 
impacts funtion 
sudden onset 
following accident/trauma 
pain 
limp/refusal to walk 
over 2SDs from the mean for normal

Question 2

Out-Toeing

Answer 2

early walkers
result of increased hip ER position
result of femoral or tibial external torsion
normal - if bilateral

Question 3

In-Toeing

Answer 3

'pigeon toed'
result of femoral antetorsion IR
tibial IR
foot metatarsus adductus 
should improve over time

Question 4

Genu Varum

Answer 4

‘bow legged’
normal up until 2.5 yrs
should correct with weight bearing
normal when symmetrical and resolving

Question 5

Genu Valgum

Answer 5

‘knock knees’
max at 3-4 yrs
measure weightbearing angle between femur and tibia
measure distance between medial malleoli - abnormal in children under 2.5 yrs or at 7 yrs old
abnormal if distance is greater than 8 cm

Question 6

Pes Planus

Answer 6

'flat feet'
normal if under 4 yrs 
- large medial fat pad hides their arch 
- arch develops with weight bearing 
at 6 yrs should develop a longitudinal arch 

Abnormal

• asymmetrical
• painful/localised tenderness
• significant deviation
• arch doesn’t form when rises onto toes
• functional issues