Gait abnormalities to master for the MRCPCH exams.
Pavitra Chakravarty
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Understanding the various types of pediatric clinical gait abnormalities is essential for both MRCPCH clinical and theory exams. Below is a detailed overview of common gait types, their characteristics, and associated diagnoses.
Common Types of Pediatric Gait Abnormali
1. Antalgic Gait
- Description: A protective gait pattern that reduces weight-bearing on the affected side due to pain.
- Associated Conditions: Often seen in conditions like juvenile idiopathic arthritis (JIA) or after an injury
2. Ataxic Gait
- Description: Characterized by instability and a wide base of support; children may stumble or have difficulty with balance.
- Associated Conditions: Common in ataxic cerebral palsy, cerebellar ataxia, and Friedreich’s ataxia[1][2].
3. Circumduction Gait
- Description: The leg swings outward in a semicircular motion, often due to leg length discrepancy or joint stiffness.
- Associated Conditions: Frequently observed in children with hemiplegic cerebral palsy or juvenile idiopathic arthritis[2][3].
4. Clumsy Gait
- Description: A lack of coordination resulting in frequent falls and difficulty with fine motor skills.
- Associated Conditions: May indicate underlying neurological issues such as mild cerebral palsy or other developmental disorders[2][3].
5. Spastic Gait
- Description: Characterized by stiff legs that are held close together, often dragging the feet.
- Associated Conditions: Commonly seen in upper motor neuron lesions such as diplegic or quadriplegic cerebral palsy[1][4].
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6. Stepping Gait
- Description: The child lifts their leg high at the hip to clear the ground, resembling climbing stairs.
- Associated Conditions: Observed in lower motor neuron diseases like spina bifida and Charcot-Marie-Tooth disease
7. Toe-Walking Gait
- Description: Walking on the toes without heel contact; can be habitual in young children but may persist.
- Associated Conditions: Persistent toe walking can indicate neuromuscular disorders such as cerebral palsy
.8. Trendelenburg Gait
- Description: A waddling gait caused by weakness in the hip abductors, leading to hip drop on the contralateral side.
- Associated Conditions: Seen in conditions like Perthes disease or muscular dystrophies[1][.
9. In-toeing and Out-toeing
- In-toeing: Feet point inward during walking; often resolves naturally with growth.
- Out-toeing: Feet point outward; can be due to rotational deformities of the femur or tibia[1]
Clinical Relevance
Understanding these gait patterns is crucial for diagnosis and management in pediatric patients. Each gait type may indicate specific underlying conditions that require tailored interventions, ranging from physical therapy to surgical options depending on severity and underlying pathology.
This knowledge is not only vital for clinical practice but also for theoretical examinations, where recognizing and diagnosing gait abnormalities can significantly impact patient outcomes.