Abnormal gait patterns in children

Abnormal gait patterns in children

The following is a list of abnormal gait patterns which may be seen in children and which may need further evaluation

Circumduction gait

• Excessive hip abduction as the leg swings forwards
• Typically seen with a leg length discrepancy, with a stiff/restricted joint movement as in JIA, or with unilateral spasticity as in hemiplegic cerebral palsy.

Spastic gait

• Stiff, foot-dragging with foot inversion. This is often seen in upper motor neurone neurological disease (eg, diplegic or quadriplegic cerebral palsy, stroke).

Ataxic gait

• Instability with an alternating narrow-to-wide base.
• Seen in ataxic cerebral palsy affecting the cerebellum, in cerebellar ataxia, and inFriedreich's ataxia.

Trendelenberg's gait

• Results from hip abductor muscle weakness or hip pain. While weight-bearing on the ipsilateral side, the pelvis drops on the contralateral side, rather than rising as is normal. With bilateral hip disease, this leads to a waddling 'rolling sailor' gait with hips, knees, and feet externally rotated.
• May be observed in Legg-Calvé-Perthes disease, slipped upper femoral epiphysis, developmental dysplasia of the hip, arthritis involving the hip, muscle disease (eg, inherited myopathies), and neurological conditions.

Toe-walking gait with absent heel contact

• Habitual toe walking is common in children and associates with normal tone, range of movement around the feet and normal walking on request. However, persistent toe walking is observed in spastic upper motor neurone neurological disease (eg, cerebral palsy). It can (rarely) be a presentation of mild lysosomal storage disorder.

Stepping gait

• The entire leg is lifted at the hip to assist with ground clearance.
• Occurs with weak ankle dorsiflexors, compensated by increased knee flexion.
• Observed in lower motor neurone neurological disease (eg, spina bifida, polio) and peripheral neuropathies (eg, Charcot-Marie-Tooth disease).

'Clumsy' gait

• This term is commonly used to describe difficulties in motor co-ordination (fine and gross motor skills).
• The child may present with frequent falls, and with difficulty in self-help skills such as dressing or feeding at school.
• Poor handwriting and learning disabilities may be noted.
• It is important to exclude specific, albeit mild, neurological disabilities (cerebral palsy, cerebellar ataxia, or lower motor neurone disorders), inflammatory arthritis or myopathies, and orthopaedic problems such as in-toeing.
• Dyspraxia is a term for children with delayed motor development who fall in the bottom 5% for their age group. By definition this includes 5% of children and is a late-maturation problem which tends to be familial and is more common in boys. It causes 'clumsiness' but there is no specifically altered gait.

Antalgic gait (caused by pain)

• Reduced time spent weight-bearing on the affected side.
• A multitude of possible causes.
• A smaller child may just present with unwillingness to weight-bear, so an index of suspicion is required.
• May be observed in juvenile idiopathic arthritis (JIA), although children do not always complain of pain.