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Gait abnormalities are present in people of all ages. Observational gait assessments are often used by clinicians to identify these deviations from a normal pattern, however these assessments can be more difficult with children as their gait pattern matures over time. As children begin to walk, they typically use a wide base of support, with short, quick steps. Over time, they develop a heel strike, arm swing, a narrower base of support, and an increased walk ratio as a fully mature gait pattern is realized around the age of 7. Due to this evolution in gait, abnormalities can be difficult to recognize from observation alone. Instrumented gait analysis allows for more in-depth, precise results that can be compared with age-matched data.

The following takes a deeper dive into evaluating gait analysis in children: 

What kind of gait are common in children?

Several common types of abnormal gait patterns can be found in children, which include: 

  • Toe walking occurs when a child walks on the balls of his or her feet instead of using a heel-to-toe pattern. This pattern is not uncommon to see in young children and often is resolved naturally. In cases, that toe walking persists; a range of motion exercises, stretching, bracing and at times surgery can be required to correct this deviation.  If toe walking goes uncorrected it can lead to balance issues, inefficient gait pattern, foot deformities, and knee hyperextension. Toe walking can be idiopathic in nature but is commonly seen in neurologic conditions such as cerebral palsy.
  • Tibial or femoral rotation is caused by a twisting of the thigh or lower leg. This leads to the knees and/or toes to be pointing inwards, creating a walking pattern known as in-toeing. Slight in-toeing is not uncommon in young children and can often self-correct as the child matures. Intoeing beyond 15 degrees can lead to inefficient gait patterns and potential knee and hip joint issues over time. Therapeutic or surgical intervention may be necessary to correct rotational issues.
  • Crouch gait is a combination of hip and knee flexion and excessive ankle dorsiflexion (action of raising the foot upwards towards the shin). This pattern is typically caused by lack of range of motion at the joints and leads to a very inefficient gait pattern that can cause damage to the joints over time. Range of motion exercises and surgery may be used to correct this gait pattern.
  • Stiff-knee gait is a lack of adequate knee flexion in the swing motion. This can be due to a lack of strength and muscle control or a lack of range of motion at the knee joint. This can make foot clearance difficult, leading to tripping. In order to gain foot clearance, hip hiking or circumduction patterns are often be used. Knee range of motion exercises, stretching or surgical intervention may be needed to correct this deviation.
  • Flat Feet are seen when the mid-foot arch breaks down. The arch is relied upon for proper foot biomechanics during gait. Targeted physical therapy, arch supports, bracing, and surgery can be used to correct this deviation.

Common causes of gait disorders in children are neurological diseases, such as cerebral palsy, spina bifida, autism, and CMT. Other causes include hip dysplasia and juvenile arthritis.

Are gait disorders diagnosed differently in children than in adults? 

Identifying gait disorders in children is not all that different than identifying them in adults. In both cases, it is important to view a person’s gait through the lens of their own case history and compare with expectations, given their age and other factors. Typically, a gait abnormality is recognized by observational gait analysis, which can be done with both adults and children. It is important to pay close attention to a child’s gait over time to observe the progression of their gait pattern. If instrumented gait analysis is used, objective data can be tracked over time and compared with gender and age-matched normative data to help determine if a gait deviation needs special attention or not.  

How can the Zeno Walkway + PKMAS software make a pediatrician’s job easier?

While observational gait analysis in children is often the first step in identifying a gait disorder, it should not be used exclusively to make the characterization. Observational gait analysis in children is subjective and can lead to poor validity, reliability, responsiveness, and precision. Using effective gait analysis tools, such as the ProtoKinetics Zeno Walkway and PKMAS software, allows for objective measurement to accurately track gait function over time and compare that data to normative values.

For example, a child may have apparent in-toeing at an initial visit. Using an instrumented gait analysis, that in-toeing can be quantified. In a future visit, the procedure can be used again to see if the in-toeing is improving naturally, remaining the same, or getting worse. Quantifying that change over time can help determine if therapeutic, surgical, or no intervention is required.

What indicators should a guardian and/or pediatrician look for when determining gait abnormalities? 

As mentioned before, in typical development, a child’s gait pattern may change as the child grows. While that is something to take into consideration, if you find that he or she is frequently complaining about foot, knee, hip, or joint pain in general, abnormal gait function could be the source. If you see patterns showing asymmetry between the left and right sides, trouble with foot clearance or foot-dragging, toe walking, balance issues, or other patterns described earlier, more in-depth gait analysis may be helpful.

What’s the next step if a child has an abnormal gait pattern?

Pediatric clinicians often have experience with common gait deviations in children. Even with this experience, instrumented gait analysis can provide important insights through quantification, data comparison, and longitudinal tracking. There are many hospitals, clinics and universities with instrumented gait analysis equipment (some with complete dedicated laboratories for testing). If a child presents with an abnormal gait pattern, it can be helpful to seek out instrumented gait analysis testing.