Normality and gait issues Flashcards
What is meant by “normal” in childrem
A wide variation in physiological structures.
Function is more important than the form
Labels should be avoided
What are some common deformities that are actually normal for kids?
Physiological bow legs that knock together Age of walking Intoeing (and tripping) Flexible flat feet Curly toes
In regards to bendy legs what is the treatment plan?
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
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?
12 months
Femoral anteversion
Interior tibial torsion
Metatarsus adductors
What is femoral anteversion
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
What is internal tibial tosrion
Increaed thigh/foot angle
90% spontaneously resolve
Can also use splints, wedges or insoles
What is metatarsus adductus
Problem causing bowing of the feet
90% resolve by 1 year
There is no risk of OA
When is intoeing operated on
When is flexible flat feet treated
When are curly toes treated
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
What is the best way to do gait analysis
Obervational- eyes and floor, not ideal
Video- equipment, camera and floor
Limitation- single/orthogonal view
3D instruments are best, e.g. force plates
What is a gait cycle
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
Define:
Step length
Stride length
Walking base
Cadence
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
What are the stages of the gait cycle?
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
What is involved in the stance phase
Heel contact- inital contact Foot flat- loading response Midstance- Heel toe- terminal stance Toe off- pre swing
What is involved in the swing phase?
Acceleration- inital swing
Midswing- swinging limb overtakes the limb in stance
Deceleration- terminal swing
What is the time distribution of the gate
Stance vs swing
stance phase- 60% of gait cycle, swing-40%
Single support-40%, double support-20%
What occurs with increasing speeds?
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
Where is the centre of gravity?
How can it be displaced?
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
Which forces have the most influence on gait
Gravity
msucular contraction
inertia
floor reaction
What is an antalgic gait?
Gate pattern during which stance phase is shortened. Increase in stance of unaffected side.
Common causes include splinter in foot, OA, tendinitis
What is Trendelenbergs gait?
Lateral trunk tilt Usually unilateral bilateral= waddling gait Common causes: painful hip, hip abductor weakness, leg length discrepency, abnormal hip joint
What is a swing leg gait?
Functional leg length discrepancy Swing leg longer than stance leg 4 common compensations Circumduction Hip hiking Steppage Vaulting
What is an increased walking base gait?
Normal walking base 5-10cm
Common causes abducted knee, valgus knee
Cerebellar ataxia, proprioception deficits
What in an inadequate dorsiflexion gait?
Foot slap during stance face
Toe drag during swing phase
Caused by weak tibialis anterior, spastic plantar flexors
What is an excessive knee extension gate?
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)
What are the 5 s’s of identifying illness
Symptoms- night pain Symmetry- lack of it Stiffness- jointsm paralysis knee=hips Syndromes- associated features Systemic illness- pyrexia
What do these symptoms suggest?
Knee pain
Night pain
Knee pain= hip
Night pain- infection or tumour
