Key Insights On Assessing Pediatric Gait

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What The Radiographs Can Reveal

Radiographs can be useful in facilitating an accurate assessment of the precise nature of the deformity if the problem originates in the foot or ankle. The most useful radiographs tend to be the AP and lateral views. However, with certain deformities, a medial or lateral oblique view is indicated and very useful. Once again, having a firm knowledge of the normal structural relationships is the key to proper evaluation of the patient’s radiograph.

When focusing on the lateral view radiograph, note the changes from normal of the calcaneal inclination angle and talar declination angle. Also note the relationship of the dorsal border of the first metatarsal with respect to the dorsal border of the second metatarsal. When evaluating the AP view, it is important to note the metatarsus adductus angle and all aspects of a bunion deformity if one is present radiographically.

The lateral aspect of the foot may show significant abduction by the calcaneocuboid angle measurements. One can also note potential changes within the calcaneal structure with this view. Lastly, an oblique view and the Harris Beath type view can help to identify tarsal coalitions present in the pediatric population.

Author(s): 
Ron Raducanu, DPM, FACFAS, FACFAP

How thorough is your evaluation of pediatric gait? Emphasizing the value of gait assessment in fostering an accurate diagnosis and appropriate treatment, this author offers pearls and nuances in evaluating the stance and ambulation of pediatric patients.

   Too often, many podiatric examinations begin with only focusing on the feet and not on assessing the body as a whole. Many podiatric physicians rely on their hands and what they see when evaluating the foot only, rather than taking a systematic approach to learning about how the malalignments in the body can contribute to foot deformities.

   Examining patient gait and stance can be an invaluable aspect of diagnosing podiatric conditions. Podiatrists must take extra care when analyzing children’s gait, as pediatric patients present special concerns and can be fairly unpredictable when one attempts to assess them.

   The psychosocial aspects of evaluation and management of children’s foot problems loom much larger than in the adult population. Children must feel at ease with their doctor and must be comfortable with their surroundings before one can initiate a true attempt at a concise diagnostic process.

   In addition, physicians must take into account the comfort level of the pediatric patient’s parents. This has a huge impact on how the evaluation of the patient proceeds. Have a thorough discussion with the parents regarding the child’s past medical history and when the child reached growth landmarks. Also discuss the family history of disease, including issues such as a history of muscular dystrophy or Charcot-Marie-Tooth disease.

Essential Tips For Evaluating Stance

   When it comes to evaluating the pediatric patient, first observe his or her natural stance position. The more comfortable children are with you, the less likely they will have a rigid, at-attention stance, which children sometimes assume when adults ask them to stand up straight. This very unnatural position can make it difficult for the podiatric physician to get a true picture of stance as it will potentially alter and exaggerate some of the natural body positions that are essential to the examination.

   Effective examination of a proper stance position can show various attributes that can lead to a more concise diagnosis. This is valuable when assessing exactly where the deformity originates in the flow of shoulder, spine, hips, knee, ankle or foot segments.

   Shoulder and spine position can have a profound effect on lower extremity alignment. If there is a severe kyphosis, lordosis or scoliosis, one can isolate the origin of the deformity and make the proper referrals.

   Malformations or physiological progression of hip retro- or ante-version can also affect lower extremity alignment. Once again, this can help in isolating the origin of the deformity so the podiatrist can facilitate referrals with other professionals who may need to be involved in the care of this patient. For instance, a parent may complain that his or her child’s toes point out. This may result from a hip deformity rather than a foot deformity.

   Evaluate the knee position while the patient is standing. Remember that there is a physiological progression of knee position in the frontal plane. Most newborns will present with a genu varum attitude but this should revert to a more straight legged presentation between the ages of 18 and 24 months.

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