LIMPING CHILD

Prof. Dr. Ibrahim Rakha

Professor and Chairman, Department of Orthopedics

Faculty of Medicine, Suez Canal University

OBJECTIVES(1) To understand the physiology of normal

walking.

(2) To be able to analyze the determining factors of normal walking.

(3) To be able to assess a child with abnormal gait.

(4) To know the causes of limping.

(5) To diagnose and put a plan of management of a case of limping child.

• The primary objective of human locomotion is translation of the body from one place to another.

• Gait is a dynamic repetitive act affected by:

Trunk sway

Arm swing

Head motion• Normal walking is relatively effortless with a

minimum expenditure of energy.

• GAIT CYCLE: From heel strikes the ground and next heel strike of the

same limp. It consists of two phases:

1- stance 2- swing

• STRIDE LENGTH:The distance traveled in the same time span as gait cycle.

• STEP LENGTH :From H.S of one foot to the H.S of the opposite foot

• CADENCE :The number of steps per minute

• WALKING VELOCITY:Speed of movement in one duration in cm\sec.

Gait Cycle

• Stance Phase :

• Swing Phase

E.D.S M.S T.S L.D.S

12% 23% 15% 12%H.S 62%0

I.S M.S T.S

16% 9% 18%100%

Factors determining the normal gait:• Pelvic rotation :4 degrees forward swing limb

4 degrees backward stance limb

• Pelvic tilt in horizontal plane :

• Knee flexion after heel strike in stance phase

• Foot and Ankle motion• Knee motion• Lateral displacement of the pelvis• limb length equality.

Muscle action in the gait :• To Stabilize isometric contraction(same length)

• To Accelerate concentric contraction(shorten)

• To Decelerate eccentric contraction (longer)

-The development of mature gait depends upon maturation of C.N.S(postural ,labyrinthine and rightining reflexes ).

-The adult pattern of gait develops between 3-5 years of age.

Assessment of patient with gait abnormality

(1) Examination:

• walking on feet ,toes and heel

• Run

• Stair climbing

• Tandems walk

• walk forward and backward 6 steps with eye open and eye closed

(2) Measurements for limb length (discrepancy)

(3)Examination for deformities and joint stiffness

(4) Assessment of muscle power

(5)Neurological examination

(6) Radiological assessment

(7) Electro-Diagnosis

PATHOLOGICAL GAIT

Causes : (1) Muscle weakness:(source of motion )• Glut.Med (Hip Abd) unilateral (lurching)

bilateral (wadding) • Glut .max (hyperextension of the trunk)

• Quadriceps muscles locking

paralysis giving way

support his knee with

his hand on the thigh • Gastrocenimus muscles responsible for final

propulsion in push off portion of stance phase

(2) Deformities of bones and joints (Articulated lever )

• Ankylosis of joint(hip or knee )

• Deformities of B&J genuvarum ,valgum,hip flexion

• painful affection of bone and joint

(antalgic gait : decreased stance phase on the affected limb)

• congenital dislocation of hip Trendlenburg gait

(3) Neurological disorders

“disturbed awareness of the need for action and control of motion “

• spastic gait hypertonicity -hyperreflexia

• ataxic gait spinal ,cerebellar ,combined

• dystrophic gait myopathy and muscle dystrophy