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Paediatric Gait Abnormalities

Normal Gait Development in Children

It’s a Euphoric moment as a parent when our child starts walking. Their initial clumsy walk, never fails to bring a smile. But when the child does not start walking when compared to his peers or the manner of walking is different, it causes significant anxiety as a parent. Most occasions, this difference is normal for the individual child. A paediatric Orthopedician like Dr Shravan, will be able to discern the same, with a simple examination and analysis.

Gait, or the manner of walking, undergoes significant changes as children grow and develop. A normal gait cycle consists of a series of rhythmic, alternating movements of the limbs and body that result in forward motion. Key phases of normal gait development include:

    1. *Toddlers (1-3 years)*:
  • Wide base of support
  • Rapid cadence
  • Short stride length
  • Flat-footed steps
  • Limited arm swing
  • Slightly out-toed foot progression angle
    2. *Preschoolers (3-6 years)*:
  • Narrowing base of support
  • Increasing stride length
  • Heel-to-toe pattern begins to develop
  • Improved balance and coordination
    3. *School-Aged Children (6 years and older)*:
  • Gait becomes more adult-like
  • Heel-to-toe walking is well established
  • Arm swing and trunk rotation become more coordinated

Common Gait Abnormalities in Children

    1. *Toe Walking*:
  • Persistent walking on the toes or balls of the feet beyond the toddler years.
  • Often idiopathic but can be associated with neurological conditions such as cerebral palsy or muscular dystrophy.
    2. *In-Toeing (Pigeon Toes)*:
  • Feet turn inward while walking.
  • Common causes include femoral anteversion, tibial torsion, and metatarsus adductus.
    3. *Out-Toeing*:
  • Feet point outward while walking.
  • Less common than in-toeing, can be due to external tibial torsion or femoral retroversion.
    4. *Limping*:
  • An asymmetrical gait pattern indicating pain, weakness, or structural abnormalities.
  • Causes include infections, trauma, juvenile idiopathic arthritis, or developmental dysplasia of the hip.
    5. *Antalgic Gait*:
  • A limp that develops to avoid pain in one leg.
  • Shortened stance phase on the affected side.
    6. *Trendelenburg Gait*:
  • Dropping of the pelvis on the contralateral side during the stance phase.
  • Indicates weakness in the hip abductor muscles, often due to developmental hip dysplasia or neurological disorders.
    7. *Spastic Gait*:
  • Stiff, awkward movements, often with scissoring of the legs.
  • Typically seen in children with cerebral palsy

When to Consult a Pediatric Orthopedic Surgeon

Consultation with a pediatric orthopedic surgeon is advisable when:

    1. *Persistent or Severe Gait Abnormalities*:
  • Abnormal gait patterns that do not resolve by age 3-4 or that worsen over time.
    2. *Associated Symptoms*:
  • Pain, swelling, or tenderness.
  • Noticeable asymmetry or deformity.
  • Frequent falls or difficulty walking.
    3. *Underlying Conditions*:
  • Suspected neuromuscular disorders (e.g., cerebral palsy, muscular dystrophy).
  • Developmental abnormalities (e.g., hip dysplasia, clubfoot).
    4. *Impact on Daily Activities*:
  • Gait abnormalities that significantly interfere with the child's ability to engage in normal activities.
    5. *Referral from Primary Care Provider*:
  • If a primary care provider or pediatrician identifies concerns during routine examinations.
Early evaluation and intervention by a pediatric orthopedic specialist like Dr Shravan, can help address and manage gait abnormalities, potentially preventing long-term complications and improving the child's overall mobility and quality of life