How To Recognize Pediatric Gait Abnormalities

Author(s): 
By Ronald L. Valmassy, DPM

In order to treat lower extremity pediatric problems, it is essential to have a sound knowledge of the normal and abnormal development of the child’s lower extremities. As structural and positional developmental changes take place in a dynamic and continuous fashion, you must have a strong grasp of when and how the changes occur during normal maturation. Once you become comfortable with this knowledge, you can successfully diagnose and treat pediatric lower extremity gait abnormalities.
As many have stated, the early years of development represent the golden years of treatment when you may favorably influence lower extremity development and gait. Therefore, you need to be able to identify conditions that may spontaneously improve and resolve over time versus those problems that will require treatment. Although you will see a variety of traumatic or dermatological problems in the pediatric patient, the vast majority of parental concerns regarding the developing child focus on angle of gait, flatfooted gait, and unsteady and unstable gait problems.
Unfortunately, the podiatric and orthopedic literature does not contain any long-term studies indicating whether early treatment of pediatric deformities has any long-term benefits. However, from a practical point of view, I feel many foot problems which occur in the adolescent and adult are attributable to the abnormal mechanics of the individual. In that these changes are recognizable in the pediatric patient population, my personal feeling is early recognition and conservative management of gait abnormalities can only help to improve the overall lower extremity development and function of the child as he or she matures and develops into an adult.

Patient History Essentials
In regard to getting a history, you should spend a moderate amount of time with the parent to develop a profile for the child’s overall development. The salient areas of discussion should include:
• perinatal history;
• neuromuscular developmental history;
• family history;
• sleeping and sitting positions;
• a history of growing pains;
• an indication of shoe wear or replacement patterns;
• the overall level of the child’s activity; and
• the child’s ability to participate in athletic or exercise-related programs.
During the initial discussion, parents may tell you their child has a history of excessive shoe wear; trips, falls and/or fatigues easily; complains of cramping; or is generally unable to participate in normal day-to-day activities. Overall, this typically indicates abnormal lower extremity function and development and should alert you to the probability of conservative management.

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