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Pediatric Gait Abnormalities: Understanding and Addressing Concerns

Learn about late walking, intoeing, tonal abnormalities, and other gait issues in children. Helpful insights for parents regarding normal development. Comprehensive guide to identifying concerns and when to seek physiotherapy support.

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Pediatric Gait Abnormalities: Understanding and Addressing Concerns

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  1. Gait Abnormalities in Children Madeleine Szadurski, Head of Children’s Physiotherapy Royal Free Hospital February 2012

  2. Late walking • Intoeing • Tonal abnormalities • Toe walking • Flat feet

  3. Camden very mixed population – racial mix alters range of “normal variants” • Maturation of gait pattern – helps parent understand normal development

  4. Normal gait parameter Walking age Chronological age is less important than developmental process

  5. Questions • Is child crawling? • Do they pull to stand independently? • Can they stand without support? If all are YES, no real concerns – WATCH AND WAIT

  6. 13 – 15 months • Only stand tiptoed • Cannot get into standing without help or being placed • Won’t tolerate feet on floor • Placed in sitting but cannot move out of position • No crawling or bottom shuffling CONCERN– ask for a physio review

  7. Late walkers - NO • 12-14 months not walking yet • No abnormalities in other areas of development • Watch, wait, reassure • Hypermobile 12-16 months • Watch, wait, reassure • If still not walking at 16 months YES refer

  8. Symmetry • Intoeing one leg only – caution babies/toddlers should be symmetrical

  9. Tone • Hypotonia may be significantly both delay walking and cause inbalance

  10. Hypermobility • Too much movement, especially at hips will make early walking difficult. More often seen in females. Usually family history of flexibility • Ask parents about family history

  11. Low core stability • Often seen if child walked earlyor did not crawl. Trunk stability did not develop so not strong enough to balance in walking. • Poor crawling posture • Weak sit up • Later poor single leg balance 2yrs+

  12. Mild abnormal neurology • 6 cases in last 2 years of late diagnosis hemiplegia. • Referred to foot clinic for: • intoeing on one leg • hip irritability • toe walking • flat feet • unstable gait

  13. Toe walker • Increase tone • Diplegia? • Reduced tone • Muscle disease? • Reduction in ankle passive movement • Muscle disease or diplegia? • Ideopathic toe walkers • Poor core stability • Sensitive to touch • Often premature babies • Also linked to autism

  14. Flat feet • Leaflet re normal foot development • What is normal for family? • Does pain come too? • Weight • Generalised low tone, poor level of fitness • Can you see an arch in toe standing? • Is heel straight?

  15. Who to send to physio? • Tonal abnormality • Loss of range • Asymmetry • Apparent deformity • Increased falling

  16. Late walking – who does physio want to see? Questions: • How late? • Are all other developmental milestones normal? • Is child alert and curious? • Timeframe of other developmental steps – crawling etc. • Family norms.

  17. Late walkers - YES • 14 months and not pulling to stand • Not moving on floor at all at 10 months • Will stand if placed against furniture but cannot get up themselves at 12 months

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