Gait Abnormalities in Children

2. Gait Abnormalities in Children Madeleine Szadurski, Head of Children’s Physiotherapy Royal Free Hospital February 2012

3. Late walking • Intoeing • Tonal abnormalities • Toe walking • Flat feet

4. Camden very mixed population – racial mix alters range of “normal variants” • Maturation of gait pattern – helps parent understand normal development

5. Normal gait parameter Walking age Chronological age is less important than developmental process

6. Questions • Is child crawling? • Do they pull to stand independently? • Can they stand without support? If all are YES, no real concerns – WATCH AND WAIT

7. 13 – 15 months • Only stand tiptoed • Cannot get into standing without help or being placed • Won’t tolerate feet on floor • Placed in sitting but cannot move out of position • No crawling or bottom shuffling CONCERN– ask for a physio review

8. Late walkers - NO • 12-14 months not walking yet • No abnormalities in other areas of development • Watch, wait, reassure • Hypermobile 12-16 months • Watch, wait, reassure • If still not walking at 16 months YES refer

9. Symmetry • Intoeing one leg only – caution babies/toddlers should be symmetrical

10. Tone • Hypotonia may be significantly both delay walking and cause inbalance

11. Hypermobility • Too much movement, especially at hips will make early walking difficult. More often seen in females. Usually family history of flexibility • Ask parents about family history

12. Low core stability • Often seen if child walked earlyor did not crawl. Trunk stability did not develop so not strong enough to balance in walking. • Poor crawling posture • Weak sit up • Later poor single leg balance 2yrs+

13. Mild abnormal neurology • 6 cases in last 2 years of late diagnosis hemiplegia. • Referred to foot clinic for: • intoeing on one leg • hip irritability • toe walking • flat feet • unstable gait

14. Toe walker • Increase tone • Diplegia? • Reduced tone • Muscle disease? • Reduction in ankle passive movement • Muscle disease or diplegia? • Ideopathic toe walkers • Poor core stability • Sensitive to touch • Often premature babies • Also linked to autism

15. Flat feet • Leaflet re normal foot development • What is normal for family? • Does pain come too? • Weight • Generalised low tone, poor level of fitness • Can you see an arch in toe standing? • Is heel straight?

16. Who to send to physio? • Tonal abnormality • Loss of range • Asymmetry • Apparent deformity • Increased falling

17. Late walking – who does physio want to see? Questions: • How late? • Are all other developmental milestones normal? • Is child alert and curious? • Timeframe of other developmental steps – crawling etc. • Family norms.

18. Late walkers - YES • 14 months and not pulling to stand • Not moving on floor at all at 10 months • Will stand if placed against furniture but cannot get up themselves at 12 months