Here is another nice review. Consider Sever’s with all your younger heel pain patients
We posted on this a few weeks ago. see here:http://thegaitguys.tumblr.com/…/clinical-tidbit-heel-pain-i…
More on the “little guy”
We have been following this little guy for some time now. If you have not been keeping up, perhaps you should read here, here and here 1st.
So, what do we see in these latest pictures?
Top left: neutral view.
- He enjoys flip flops; probably not the best thing for a developing kiddo, in light of the excessive engagement of the posterior compartment (and reciprocal inhibition of the anterior compartment)
- he has some tibial varum (ie bowleggedness) L > R
- he has some developmental genu valgum whnich appears to be improving (need a Q angle review? click here)
- no tibial torsion present on L: for a review on torsions, click here
- still some external tibial torsion present on R (see section below on middle shots)
Top right and bottom: full internal rotation of R thigh: compare with bottom: full internal rotation of L thigh
- he has adequate internal rotation (4 degrees needed) but not as great as left side (see bottom shot); this represents some improvement since we started
- he has generous internal rotation of the left thigh
Middle Left: full external rotation of right thigh
- note the position of the knee and the position of the foot; external tibial torsion is present. for a review of torsions, click here.
- he has limited external rotation of the right thigh (compared with the left. The knee should fall more outside the saggital plane
Middle right: full external rotation of the left thigh
- note the position of the knee and the position of the foot; internal tibial torsion is present.
- he has generous external rotation of the left thigh (compared with the left)
of other significant note: most of his calcaneal valgus has resolved; longitudinal arches are improved.
What now?
- He continues to develop normally and continues to improve since his original presentation to the office
- Having the child continue to walk barefoot
- Continue to wear shoes with little torsional rigidity, to encourage additional additional intrinsic strength to the feet
- He should continue to limit “W” sitting, as this will tend to increase the genu valgus present
- We reviewed 1 leg balancing “games” and encouraged continuing agility activities, like balance beam, hopping, skipping and jumping on each leg individually
- added in using a push and pedal bike
- added in heel walking exercises
Ivo and Shawn. Bald. Good looking. Extraordinary Gait Geeks. Taking the world of gait literacy by storm with each and every post.
Treat your children well.
We think Crosby, Stills, Nash and Young had it right…
look at this conclusion: “Shoes affect the gait of children. With shoes, children walk faster by taking longer steps with greater ankle and knee motion and increased tibialis anterior activity. Shoes reduce foot motion and increase the support phases of the gait cycle. During running, shoes reduce swing phase leg speed, attenuate some shock and encourage a rearfoot strike pattern."
let’s break that down a bit:
"Shoes affect the gait of children.” Shoes effect EVERYONE’S gait, not just kids. They alter the ground reactive forces, limit some ranges of motion and thus can promote a compensation or mechanics that you may not have seen previously. Take off one of your shoes. Lift your toes up slightly so you are centered on your tripod. Stand on your “barefoot” leg with your eyes closed. See how long you can stand without faltering. Now repeat that with your shod foot. Some difference, eh? I thought shoes dampened proprioception…They do. But they also give you more support and mechanics that you didn’t have previously, so the foot doesn’t have to work as hard.
“With shoes, children walk faster by taking longer steps with greater ankle and knee motion and increased tibialis anterior activity.”Remember we are talking about kids here. Longer steps because with a shoe we promote heel rocker and because of the added support, more stability (or at least more perceived stability). This means more confidence. Greater knee and ankle motion because of the increased stride length. Greater tibialis anterior activity because of greater dorsiflexion of the foot because of the increased weight (the shoe adds ounces and this muscle must work harder to attenuate the foot as it approached midstance) and increased heel and ankle rocker.
“Shoes reduce foot motion and increase the support phases of the gait cycle.” Shoes constrain the foot and reduce available ranges of motion (yes, even non motion control shoes). Less motion (and thus proprioception) means less feedback to the brain about muscles length and tension (via muscle spindles and golgi tendon organs). The brain will need to have the foot have more contact with the ground to know where it is in space.
“During running, shoes reduce swing phase leg speed,probably due to the increased weight so it takes more to start the process of initial (early) swing
…attenuate some shock we know shoes attenuate at least initial ground reactive forces
…and encourage a rearfoot strike pattern.” most likely due to the cushioning (remember from the recent Kenyan study about barefoot heel strikers? (click here if you need a reminder) They were more likely to heel strike on softer surfaces) AND the increased stride length (which would require more ankle dorsiflexion).
Wow. Shoes really do make the, er….kid.
The Gait Guys. Making it real and increasing your shoe and gait IQ with each post.
J Foot Ankle Res. 2011 Jan 18;4:3. doi: 10.1186/1757-1146-4-3.
Effect of children’s shoes on gait: a systematic review and meta-analysis.
Source
Discipline of Exercise and Sports Science, Faculty of Health Sciences, The University of Sydney, Cumberland Campus, PO Box 170, Lidcombe, 1825, NSW, Australia. cweg6974@uni.sydney.edu.au.
Abstract
BACKGROUND:
The effect of footwear on the gait of children is poorly understood. This systematic review synthesises the evidence of the biomechanical effects of shoes on children during walking and running.
METHODS:
Study inclusion criteria were: barefoot and shod conditions; healthy children aged ≤ 16 years; sample size of n > 1. Novelty footwear was excluded. Studies were located by online database-searching, hand-searching and contact with experts. Two authors selected studies and assessed study methodology using the Quality Index. Meta-analysis of continuous variables for homogeneous studies was undertaken using the inverse variance approach. Significance level was set at P < 0.05. Heterogeneity was measured by I2. Where I2 > 25%, a random-effects model analysis was used and where I2 < 25%, a fixed-effects model was used.
RESULTS:
Eleven studies were included. Sample size ranged from 4-898. Median Quality Index was 20/32 (range 11-27). Five studies randomised shoe order, six studies standardised footwear. Shod walking increased: velocity, step length, step time, base of support, double-support time, stance time, time to toe-off, sagittal tibia-rearfoot range of motion (ROM), sagittal tibia-foot ROM, ankle max-plantarflexion, Ankle ROM, foot lift to max-plantarflexion, ‘subtalar’ rotation ROM, knee sagittal ROM and tibialis anterior activity. Shod walking decreased: cadence, single-support time, ankle max-dorsiflexion, ankle at foot-lift, hallux ROM, arch length change, foot torsion, forefoot supination, forefoot width and midfoot ROM in all planes. Shod running decreased: long axis maximum tibial-acceleration, shock-wave transmission as a ratio of maximum tibial-acceleration, ankle plantarflexion at foot strike, knee angular velocity and tibial swing velocity. No variables increased during shod running.
CONCLUSIONS:
Shoes affect the gait of children. With shoes, children walk faster by taking longer steps with greater ankle and knee motion and increased tibialis anterior activity. Shoes reduce foot motion and increase the support phases of the gait cycle. During running, shoes reduce swing phase leg speed, attenuate some shock and encourage a rearfoot strike pattern. The long-term effect of these changes on growth and development are currently unknown. The impact of footwear on gait should be considered when assessing the paediatric patient and evaluating the effect of shoe or in-shoe interventions.
http://www.ncbi.nlm.nih.gov/pubmed/21244647
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