3 year old outtoe.

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Hello everyone
Case of an excessively out toed 3 year old during gait. Trips sometimes and has an unstable ankle joint when running. Child self aligns their feet into a straighter position when standing however claws with the 2nd toe/ bilaterally.
I would appreciate some input on treatment and examination of excessive outoe in children. Thankyou

 

For a start, have you examined the ROM of the hip? Is the foot abducting relative to the leg or is the leg externally rotating along with the foot. This could be a hip ROM or direction of motion issue, it could be a femoral or tibial torsion issue, a STJ/MTJ issue, or a combination of two or more of these or something entirely different. Take a look a Ron Valmassy's book Clinical Biomechanics of the Lower Extremity for an excellent review of pediatric examination techniques. More detail would be helpful at this point.

Jeff

 

Hi,

Not near enough information there to give any advice based on what you have posted because:

• 3 year old's can normally trip
• 3 year old's can normally out toe
• 3 year old's can normally claw their toes
• 3 year old's also do funny things when they run.

These things can also be very abnormal.
Is it osseous position hip, leg or foot?
Does the child have a medical condition known to cause gait problems?
Is there a muscular restriction anywhere?

Without knowing these things, it would not be appropriate to discuss whether to treat or not.

 

Hello wanderingpod

I agree with previous posts NOT ENOUGH INFORMATION!!
Angle of gait (AOG) is a complex summation of positional and structural alignments of the lower limb namely,
Femoral position/infantile lateral hip contracture(+ve Angle)
Femoral Anteversion (-ve Angle)
Tibial Torsion (+ve Angle)
Talar Calcaneal Angle (-ve Angle)
Metatarsus Adductus / Varus (-ve)
these measures are found via rotational profiling I've found Lynn Staheli's work to be a useful insight on paediatric angles of gait.

In addition to a mechanical approach ensure you take into account paediatric musculoskeletal anatomy and general physiology they're not scaled down adults ie young children tend to be rather cephalo centred in body proportions and their pattern of myelination is cephalocaudad too meaning lower limb co-ordination lags behind the upper limb, hence infants fall over a lot.

Consider congenital problems via full birth history both pre and postnatal, Breech position, pre or post term child, Pre-eclampsia, Oligohydramnios, Delivery method, Apgar score, prescence of DDH at birth, psychomotor milestones (age of crawling, age of walking) perform a Gower's test to note proximal muscle strength.

A 3 year old is too young for formal proprioceptive tests, (Rombergs and timed single leg balance,) but general co-ordination can be established via simple questioning of ability to: Run, Jump, Kick a ball, Stair Climb (all be it not reciprocally before 4 yrs of age).

This is of course not an exhaustive list but hopefully gives some indication of things to query when assessing paediatric AOG.
Hope this helps.

Matt