During the early years there can be some obvious gait abnormalities in children. Many of these disturbances are quite common and correct themselves on their own.
Some require medical assistance if there is a considerable variation in normal gait patterns which may be due to age, family history and Musculoskeletal or Neurological condition.
Abnormal gait patterns in children
The following is a list of abnormal gait patterns which may be seen in children and which may need further evaluation:
Antalgic gait (caused by pain)
- A multitude of possible causes.
- A smaller child may just present with unwillingness to weight-bear, so an index of suspicion is required.
- May be observed in Juvenile Idiopathic Arthritis (JIA), although children do not always complain of pain.
- Excessive hip abduction as the leg swings forwards
- Typically seen with a leg length discrepancy, with a stiff/restricted joint movement as in Juvenile Idiopathic Arthritis (JIA), or with Unilateral Spasticity as in hemiplegic Cerebral Palsy.
- Stiff, foot-dragging with foot inversion. This is often seen in upper motor neurone neurological disease (eg, Diplegic or Quadriplegic Cerebral Palsy,Stroke).
- Instability with an alternating narrow-to-wide base.
- Seen in Ataxic Cerebral Palsy affecting the cerebellum, inCerebellar ataxia, and in Friedreich’s ataxia.
- Results from hip abductor muscle weakness or hip pain. While weight-bearing on the ipsilateral side, the pelvis drops on the contralateral side, rather than rising as is normal. With bilateral hip disease, this leads to a waddling ‘rolling sailor’ gait with hips, knees, and feet externally rotated.
- May be observed inLegg-Calvé-Perthes disease, slipped upper femoral epiphysis, developmental dysplasia of the hip, arthritis involving the hip, muscle disease (eg, inherited myopathies), and neurological conditions.
Toe-walking gait with absent heel contact
- Persistent toe walking is observed in spastic upper motor neurone neurological disease (eg, cerebral palsy). It can (rarely) be a presentation of mild lysosomal storage disorder.
- The entire leg is lifted at the hip to assist with ground clearance.
- Occurs with weak ankle dorsiflexors, compensated by increased knee flexion.
- Observed in lower motor neurone neurological disease (eg,spina bifida, polio) and peripheral neuropathies (eg, Charcot-Marie-Tooth disease).
- This term is commonly used to describe difficulties in motor co-ordination (fine and gross motor skills).
- The child may present with frequent falls, and with difficulty in self-help skills such as dressing or feeding at school.
- Poor handwriting and learning disabilities may be noted.
- It is important to exclude specific, albeit mild, neurological disabilities (cerebral palsy, cerebellar ataxia, or lower motor neurone disorders), inflammatory arthritis or myopathies, and orthopaedic problems such as in-toeing.
- Dyspraxiais a term for children with delayed motor development who fall in the bottom 5% for their age group. By definition this includes 5% of children and is a late-maturation problem which tends to be familial and is more common in boys. It causes ‘clumsiness’ but there is no specifically altered gait.
How Can Rehab Basics Help?
We appreciate that every child is an individual and hence a personalised treatment plan will be agreed and implemented on discussion with parents and other professionals (if involved).
Treatment plan will/may include:
- Encourage joint range of movement
- Improve Muscle strength and endurance
- Gait Analysis and Training
- Help with balance and co-ordination.
- Vestibular rehabilitation
- Posture management.
- Wheelchair assessment
- Improve stiffness and contractures
- Functional electrical Stimulation (FES)
- Working with the doctors to help with prescription of medication such as Diazepam, Baclofen, Botulinum toxin
- Splints/orthosis referral to appropriate department.
- Personalized home exercise programs.
- Recommendation to other services.
Depending on the condition Rehab Basics will work with the child and family to achieve child’s full potential.
Treatment Sessions are offered in clinics across Northamptonshire and Milton Keynes or at Home Environment.
For further information about our service or to book an appointment with Rehab Basics please contact us
Rehab Basics offers Treatment Sessions in Clinics across Northamptonshire and Milton Keynes OR at Home Environment.