ABSTRACT
In-toeing gait is common after treatment for clubfoot deformity and is often secondary to residual internal tibial torsion. The purpose of the current study was to characterize the gait pattern in children with an intoeing gait pattern associated with talipes equinovarus (TEV) deformity, identify secondary changes at the hip that occur with intoeing, and determine if these secondary effects resolve after correction of tibial torsion. Patients with a diagnosis of TEV deformity, in-toeing gait secondary to residual internal tibial torsion corrected with tibial rotation osteotomy (TRO) and complete preoperative and postoperative motion analysis studies obtained approximately 1 year apart, were included in the study. Nineteen children (19 left extremities) with a TRO at a mean age of 8.2 years met inclusion criteria. Clinical examination showed improvement in tibial torsion assessment by measure of the thigh foot axis and transmalleolar axis. Kinematically, an abnormal internal FPA was present in all cases preoperatively, was corrected to normal in 12 (63%), remained internal in 5 (26%), and was abnormally external in 2 (11%). External hip rotation was identified in 13 (68%) cases preoperatively. Hip rotation was normalized postoperatively in 7 (54%), and was unchanged in the remaining 6 (46%). TRO provides effective correction of excessive internal tibial torsion, resolution of kinematic internal knee rotation, and normalization of the internal foot progression angle in the majority of patients with TEV deformity. External hip rotation resolved in approximately 50% of cases. Overcorrection of the internal FPA is possible when secondary changes at the hip do not resolve.
Subject(s)
Clubfoot , Gait Analysis , Metatarsus Varus , Osteotomy , Postoperative Complications , Tibia , Biomechanical Phenomena , Child , Clubfoot/diagnosis , Clubfoot/physiopathology , Clubfoot/surgery , Female , Gait Analysis/methods , Gait Analysis/statistics & numerical data , Humans , Lower Extremity/physiopathology , Lower Extremity/surgery , Male , Metatarsus Varus/diagnosis , Metatarsus Varus/etiology , Metatarsus Varus/physiopathology , Osteotomy/adverse effects , Osteotomy/methods , Perioperative Period , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Retrospective Studies , Tibia/pathology , Tibia/physiopathology , Tibia/surgery , Torsion Abnormality/diagnosis , Torsion Abnormality/etiology , Torsion Abnormality/physiopathology , United StatesABSTRACT
BACKGROUND: One of the most common gait disorders in children is in-toeing. Few studies have examined the efficacy gait plate insole in in-toeing. we used more precise apparatus than previous studies. OBJECTIVES: The aim of this study was to investigate the immediate effect of gait plate insole on the angle of gait and center of pressure displacement in children with in-toeing gait. STUDY DESIGN: Quasi-experimental before -after study. METHODS: The angle of gait and center of pressure displacement were measured in 17 children aged 4-10 years with in-toeing gait. The RS scan pressure platform was employed to perform walking tests in three conditions including barefoot, with shoes only, and gait plate insole with shoes. RESULTS: The gait plate insole with shoes as well as shoes alone produced a significant 11.1° and 3.85° increase in the angle of gait in in-toeing children respectively ( p < 0.05). The medial-lateral displacement of center of pressure showed a significant difference (3 mm) in shoes only condition when compared with barefoot condition. The shoes only and gait plate insole compared with barefoot condition increased the anterior-posterior displacement by 28 and 30 mm respectively. CONCLUSION: The gait plate insole with ordinary shoes and shoes only were able to increase angle of gait and the center of pressure displacement in the anterior-posterior direction in children with in-toeing gait due to excessive femoral anteversion. Clinical relevance The use of a gait plate insole inserted in ordinary shoes can improve gait appearance in children with in-toeing gait caused by Excessive femoral anteversion.
