Normality and gait issues

Question 1

What is meant by “normal” in childrem

Answer 1

A wide variation in physiological structures.
Function is more important than the form
Labels should be avoided

Question 2

What are some common deformities that are actually normal for kids?

Answer 2

Physiological bow legs that knock together
Age of walking
Intoeing (and tripping)
Flexible flat feet
Curly toes

Question 3

In regards to bendy legs what is the treatment plan?

Answer 3

mostly physiological and very common.Most legs are straight by the teens and are rarely treated

If under 18 months and symmetrical no treatment for varus deformity
If 18m-7y and symmetrical

Question 4

What is the mean age that chidlren start walking?

Many parents worry their childs intoeing is caused by degeration or sports. What is it most commonly caused by?

Answer 4

12 months

Femoral anteversion
Interior tibial torsion
Metatarsus adductors

Question 5

What is femoral anteversion

Answer 5

Developmetal normal that allows to rotate 40 degrees each way

There is 2 degree reduction per anum meaning that 80% are at around10 degrees by 16

Question 6

What is internal tibial tosrion

Answer 6

Increaed thigh/foot angle
90% spontaneously resolve
Can also use splints, wedges or insoles

Question 7

What is metatarsus adductus

Answer 7

Problem causing bowing of the feet
90% resolve by 1 year
There is no risk of OA

Question 8

When is intoeing operated on

When is flexible flat feet treated

When are curly toes treated

Answer 8

none before 10 years

all children have flat feet. 90% resolve, in the other 10% can wear insoles

Never, no difference at all between strapping and no strapping

Question 9

What is the best way to do gait analysis

Answer 9

Obervational- eyes and floor, not ideal
Video- equipment, camera and floor
Limitation- single/orthogonal view
3D instruments are best, e.g. force plates

Question 10

What is a gait cycle

Answer 10

Single sequence of funtions by one limb
Begins when reference foot contacts the ground
Ends with subsequent floor contact of the same foot
normal gait is rhythmic alternating controlled falls

Question 11

Define:

Step length
Stride length
Walking base
Cadence

Answer 11

Step length- distance between corresponding successive points of heel contact of the opposite feet
Stride length- distance between succsesive points of heel of the same foot
Walking base-side to side distance between the line of the two feet
Cadence-number of steps per unit time

Question 12

What are the stages of the gait cycle?

Answer 12

Stance phase- limb in contact with floor
Support face- can be single support (one foot) or double support (two feet in contact with feet)
Swing phase- limb not in contact with floor

Question 13

What is involved in the stance phase

Answer 13

Heel contact- inital contact
Foot flat- loading response
Midstance- 
Heel toe- terminal stance
Toe off- pre swing

Question 14

What is involved in the swing phase?

Answer 14

Acceleration- inital swing
Midswing- swinging limb overtakes the limb in stance
Deceleration- terminal swing

Question 15

What is the time distribution of the gate

Answer 15

Stance vs swing
stance phase- 60% of gait cycle, swing-40%

Single support-40%, double support-20%

Question 16

What occurs with increasing speeds?

Answer 16

Stance phase-decreases
Swing phase- increases
Double support- decreases

Running by definition is walking without the double step
stance/swing ratio reverses
Double support disappears and double swing comes into play

Question 17

Where is the centre of gravity?

How can it be displaced?

Answer 17

Midway between the hips
Few cm infront of S2
Least energy consumption if it travels in a straight line

Vertical displacement as body moves up and down. Doesnt move much only about 5cm
Lateal displacement as opposing legs take the weight of movement. Average displacement is around 5cm

Question 18

Which forces have the most influence on gait

Answer 18

Gravity
msucular contraction
inertia
floor reaction

Question 19

What is an antalgic gait?

Answer 19

Gate pattern during which stance phase is shortened. Increase in stance of unaffected side.

Common causes include splinter in foot, OA, tendinitis

Question 20

What is Trendelenbergs gait?

Answer 20

Lateral trunk tilt
Usually unilateral
bilateral= waddling gait
Common causes: 
painful hip, hip abductor weakness, leg length discrepency, abnormal hip joint

Question 21

What is a swing leg gait?

Answer 21

Functional leg length discrepancy
Swing leg longer than stance leg
4 common compensations
Circumduction
Hip hiking
Steppage
Vaulting

Question 22

What is an increased walking base gait?

Answer 22

Normal walking base 5-10cm
Common causes abducted knee, valgus knee
Cerebellar ataxia, proprioception deficits

Question 23

What in an inadequate dorsiflexion gait?

Answer 23

Foot slap during stance face
Toe drag during swing phase
Caused by weak tibialis anterior, spastic plantar flexors

Question 24

What is an excessive knee extension gate?

Answer 24

Loss of normal knee flexion during the stance phase
Knee may go into hyperextension
Hyperextension deformity of the knee
Common causes- quadriceps weakness (mid stance)
Quadriceps spasticity (mid stance)
Knee flexor weakness (end-stance)

Question 25

What are the 5 s’s of identifying illness

Answer 25

Symptoms- night pain
Symmetry- lack of it
Stiffness- jointsm paralysis knee=hips
Syndromes- associated features
Systemic illness- pyrexia

Question 26

What do these symptoms suggest?
Knee pain
Night pain

Answer 26

Knee pain= hip

Night pain- infection or tumour