Gait plates are a semi-rigid foot orthotic that limits in-toeing by changing the line of progression. This is an important treatment modality for children with angular deformities that may cause permanent structural, strength and balance deficits.
This study compared the immediate and four-week effects of a gait plate insole versus shoes with lateral sole wedges on foot progression angle (FPA) in children with in-toeing gait. FPA is one of several standard parameters for quantifying rotational deformities such as hip internal rotation, tibial counter rotation and femoral anteversion.
In-Toe Gait
Some children and adults walk with their toes pointing inward, which is called in-toeing or walking “pigeon-toed.” Often the in-toeing is due to a twist of the top of the femur at the hip (femoral anteversion) or an inward twist of the tibia at the foot (internal tibial torsion).
Gait plates may be used to try to alter the angle that the child walks. In a gait plate, a semi-rigid shell is placed in the shoes that extends over the metatarsophalangeal joints. The unique distal edge of the gait plate creates instability under the forefoot during toe-off, which triggers a compensatory external leg rotation that realigns the gait pattern. This can be a great device to help reduce intoeing in children with skeletal abnormalities.
Gait plates should probably be used only after a thorough assessment has been done as to what segment of the lower limb is the source of the torsional gait problem. In general, these devices are probably over-used and any gait change they might make is more cosmetic than functional. In addition, the use of a gait plate without addressing what is causing the torsional gait pattern might just mask the underlying problem and could cause a more serious recurrence.
Out-Toe Gait
Generally, kids with a waddling gait are able to resolve it without intervention as they grow. However, it is worth examining the child if they are taking more time to start walking than expected or are having difficulty as they walk. This could be a sign of a lingering fetal position or that the bones in the legs are growing at different rates.
If a child is unable to stop turning their feet outward as they walk (pigeon-footed) or it persists past age three then a doctor should be called in to help prevent serious orthopedic issues later in life. The child will be examined for hip mobility, tightness and flexibility as well as the alignment of the foot and ankle joints. A neurologic examination will also be done checking nerve and muscle function as the child walks and runs. An X-ray or MRI may be ordered to check for a potential underlying problem.
Gait plates are a type of foot orthotic used to help with out-toeing. They are a semi-rigid device that is worn over the metatarsophalangeal joints to change the angle of progression during gait. littleSTEPS is the first prefabricated orthotic to utilize this design and has shown that it is effective at changing the progression of foot movement in out-toeing children. The littleSTEPS gait plate has two designs, the out-toe gait plate and the in-toe gait plate.
Pediatric Gait
The gait of children is a dynamic process. Early walkers often take their first steps with a wide base of support for stability and in a high guard position (arms held up to balance). As they develop their gait pattern evolves, resulting in more refined movements with increased step length and reduced side-to-side sway as their legs gain strength. By around 18 months of age most children achieve a stable and mature gait that allows them to run, climb stairs and jump.
Gait evaluation is a key element of any orthopaedic exam and can be performed through observation in clinic or a more formalized gait laboratory with the use of video, EMG and pedobarography(Karol 2014). A careful physical exam is critical to document hip abduction/flexion, knee range of motion, thigh-foot angles, foot break angle, toe-walking and stance phase weight distribution.
Children with an in-toeing or out-toeing gait pattern can often be treated by simply altering the direction of their foot break and retraining their leg to swing over the ball of their foot. However, if left untreated this type of gait abnormality can lead to permanent structural, strength, balance and coordination deficits. littleSTEPS(r) gait plates are semi-rigid prefabricated orthoses that effectively limit in-toeing by reorienting the break of the foot to encourage toe-out movement. They also address foot pronation, which is common in children with in-toeing gait patterns, by incorporating the features of a functional foot orthosis (deep heel cup, medial rearfoot posting and skive). This combination helps to control subtalar joint pronation during contact and midstance phases of gait.
Foot Deformities
The foot and ankle have a complex job to do, and when bones and joints become misaligned it puts abnormal strain on muscles and tendons. This can lead to pain and other problems in the foot, leg, knees, hips and back.
Foot deformities may be caused by injury, disease or birth defects. They can also occur from wearing tight shoes. A common problem is bunions, bony bumps that form on the big toe joint when the toe is forced inward by a shoe with a narrow toe box. Other problems include hammertoes, curling toes that rub against the tops of shoes, and plantar fasciitis, a painful condition that causes inflammation of the arch support.
Some foot deformities are more complex and require surgical treatment. These treatments can involve osteotomies (bone cutting and repositioning), ligament releases and tendon transfers to help rebalance and supplement weak foot muscles. For example, in cavus foot, an orthopedist might cut and reposition the calcaneus, 1st metatarsal and talon to make the foot more plantigrade and use soft tissue techniques to balance the foot.
Pediatric foot deformities such as tarsal coalition, clubfoot and accessory navicular present unique challenges for orthopedic surgeons. They often require staged surgery using external fixation with devices such as the Taylor spatial frame, which uses telescopic struts that can be lengthened or shortened according to a computer-generated plan.