Gait Analysis In Pediatric Patients With Flatfoot

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Author(s): 
Louis J. DeCaro, DPM

   Then I perform my biomechanical foot evaluation. I take my rearfoot and forefoot measurements (rearfoot varus, forefoot varus or valgus) with the patient in a prone position. I also observe the feet while they hang down from the examining chair. In addition, I notate callus patterns, bunions and other toe deformities, muscular tightness, etc. I then have the patient stand for me. It is important to have patients march in place for a moment and have them relax in their natural stance.

   I will then perform an overall postural assessment from head to toe, first looking for obvious asymmetries and then subtle ones. I notice the alignment of the knees and hips. Are they in alignment with each other or rotated differently? Are the hips and pelvis equal in height? Are the shoulders even in height? Is one knee more flexed than the other? Is one foot turned in or out more than the other? Are the arch heights similar? Are there orthopedic differences that are noticeable (i.e., a bunion on one foot but not the other)? I ask the patient specific questions based on what I am seeing. For example, I may ask if anyone has ever told the patient he has a limb length discrepancy or if one knee or hip bothers him more.

   Then I finally ask the patient to walk down a hallway for me. I have patients do this several times as I observe their hips, knees, ankles and feet, and how they are aligned with each other during the gait cycle. I look for heel whipping or circumduction. I try to notice any differences in the gait from the left side versus the right. When I tie all of this together, I determine the patient’s foot type and can begin to predict future problems. This is when I often learn of orthopedic problems that run in the family, even though I have tried to elicit this information previously.

When Emphasizing Patient Education Leads To Referrals

Once I have determined the patient has flat feet, whether he or she has the D or F foot type, the education begins. I spend a considerable amount of time during the visit educating the patient and family about the foot type and the impact on the body. I inquire about family, including parents, siblings, children and grandchildren if appropriate, etc. I typically demonstrate an exaggerated version of the patient’s gait so the parents may understand how the child is walking and how this relates to his or her symptoms or dysfunction.

   Typically, parents and older pediatric patients are more than pleased as they have gotten more than they bargained for. They have had evaluation and treatment but also a thorough education on their foot type, its impact on their lives and where to go to learn more about their foot type.

   Keep in mind that older patients you are treating surgically and non-surgically with foot orthoses often have offspring. You have to start thinking about them. It is amazing how appreciative patients will be because you ask about their children and/or grandchildren. They will gladly bring them in for a screening.

   Dr. DeCaro specializes in pediatrics with a special interest in sports medicine and biomechanics for both adults and pediatrics. He is the Vice President of the American College of Foot and Ankle Pediatrics. Dr. DeCaro is currently in private practice with an office in West Hatfield, Mass. He is a member of the surgical and medical staff at Franklin Medical Center and Holyoke Hospital in Holyoke, Mass. Dr. DeCaro is the Director and originator of the biweekly Adult Gait Labs Biomechanics Clinic and directs a weekly Lower Extremity Podo-Orthopedic Clinic.

   The author offers special thanks to Joe Coletta, CPed, and Kay Brooke-Willbanks, PMA, for their contributions.

References
1. Riddiford-Harland DL, Steele JR, Baur LA. Are the feet of obese children fat or flat? Revisiting the debate. Int J Obes (Lond); 2011. 35(1):115-20.
2. Villarroya MA, Esquivel JM, Tomas C, et al. Assessment of the medial longitudinal arch in children and adolescents with obesity: footprints and radiographic study. Eur J Pediatr. 2009; 168(5):559-67.
3. Mickle KJ, Steele JR, Munro BJ. The feet of overweight and obese young children: are they flat or fat? Obesity (Silver Spring). 2006; 14(11):1949-53.

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