Abnormal Gait (Pediatric)

How does gait develop in children?

The gait of toddlers is usually unsteady and characterized by bowed legs, hands and arms spread out for balance, and an uneven series of quick flat-footed steps.

Legs straighten out as babies learn to walk. Heel strike develops around 15 to 18 months accompanied by swinging arms. Running and the ability to change direction occur after age 2 (after frequent falls). In early childhood, toes are often turned inward. Normal gait is generally established close to age 6.

Common difficulties with gait are limping, pain, dragging leg, foot drop, one leg swinging outward, crossing of legs, intoe-ing or “pigeon toes,” toe walking, knock knees, poor coordination, or stiff arms.

What is abnormal gait?

Abnormal gait generally results from impaired strength, decreased or increased range of motion, a discrepancy in leg length, problems with proprioception (knowing where the body is in space), pain, or balance. Children can compensate for these difficulties but that adaptation leads to other problems down the road.

How is abnormal gait diagnosed?

Abnormal gait must be diagnosed and treated by an experienced clinician. Two children can have a similar gait abnormality for different reasons and thus require different treatments.

Our doctors take a careful history and perform a detailed physical examination to find the underlying gait problem in children and how they compensates for it. Early intervention is critical for patients to reach their mobility potential.

What is the treatment for abnormal gait?

With our help, many children with abnormal gait attain and maintain mobility. After finding the underlying cause for this condition, our doctors may prescribe:

• Electrical Stimulation and/or Functional Electrical Stimulation: Electrodes placed on skin activate muscles to help children maintain strength and walk better.
• Injections: Lidocaine and/or steroids alleviate joint pains. Trigger-point injections may ease taut muscle bands. Botox and/or phenol injections can help specific muscles prone to spasticity.
• Oral Medications: Muscle relaxers and anti-inflammatory, pain, and/or anti-spasticity medications reduce muscle tightness.
• Physical Therapy: Specific strengthening and stretching programs fix imbalances in strength, flexibility, and coordination such as massage therapy and aquatherapy.
• Special Equipment: A customized cane, walker, brace, or orthotic helps to improve the ability to walk. We wean children to the least restrictive device and help them work toward independence.
• Surgery: We coordinate with pediatric orthopedic surgeons when surgery is appropriate. Common procedures are muscle/tendon lengthening and osteotomy (cutting of bone) for realignment or reconstruction. Correct timing of surgery and the right therapy before and after the procedure are critical for successful treatment.