Abnormal Gait in Children

Aka: Abnormal Gait in Children, Nonantalgic Gait in Children, Steppage Gait, Circumduction Gait, Equinus Gait, Gait Evaluation in Children, Pediatric Gait

1. See Also
   1. Abnormal Gait
   2. Pediatric Limp
   3. Clubfoot
   4. In-Toeing
   5. Out-toeing
   6. Metatarsus Adductus
   7. Congenital Vertical Talus
   8. Calcaneovalgus Deformity
   9. Torsional Profile
   10. Foot Progression Angle
   11. Thigh-Foot Angle
   12. Hip Rotation Evaluation in Children
2. Types: Antalgic Gait
   1. Stance phase on unaffected limb is shortened due to pain
   2. Refusal to bear weight (esp. with limited range of motion, systemic symptoms, fever) suggests Septic Arthritis
3. Types: Non-Antalgic Gait
   1. Steppage Gait
      1. Cause: Neurologic deficit interferes with foot dorsiflexion
      2. Hip and Knee Joints are flexed excessively during swing phase (allows toes to clear ground)
   2. Trendelenburg Gait
      1. Cause: Developmental dysplasia of hip interferes with hip abduction
      2. Tests: Trandelenburg Test is positive
      3. Pelvis tilts downward toward the unaffected side during the swing phase
   3. Circumduction Gait
      1. Causes
         1. Limb-length discrepancy (Galeazzi Sign positive)
         2. Knee or ankle stiffness due to underlying neurologic or mechanical disorder
      2. Appearance
         1. Stance phase: Knee is hyperextended and locked
         2. Swing phase: Affected leg is abducted or circumducted
   4. Equinus Gait
      1. Causes
         1. Cerebral Palsy
         2. Achilles tendon tight
         3. Calcaneal Fracture
         4. Foot foreign body
         5. Limb-length discrepancy
      2. Appearance
         1. Toe Walking
4. Exam: Foot Deformity
   1. Lateral view
      1. Normal neonatal foot dorsiflexed >90 degrees
      2. Rule-out fixed equinus (Clubfoot) position
         1. Tiptoe walking (foot plantar flexed)
         2. Tight heel cord
   2. Plantar view (footprint shape)
      1. Kidney bean (sole deviated medially)
         1. Metatarsus Adductus
      2. Banana (sole deviated laterally)
         1. Calcaneovalgus Deformity
   3. PA View (from behind, while in neutral position)
      1. Heel varus with inverted foot (medial malleoli apart)
         1. Metatarsus Adductus
      2. Heel valgus with everted foot (medial malleoli touch)
         1. Calcaneovalgus Deformity
5. Exam: Rotational Deformity
   1. See Pediatric Limp
   2. Torsional Profile (Leg Rotation Evaluation in Children)
   3. Foot Progression Angle (In-Toeing, Out-toeing)
   4. Thigh-Foot Angle (tibial torsion)
   5. Hip Rotation Evaluation in Children (Femoral Anteversion)
6. Exam: Angular Deformity
   1. Genu Varum (bow leg)
   2. Genu Valgum (knock knee)
7. References
   1. Rerucha (2017) Am Fam Physician 96(4): 226-33 [PubMed]