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Hi Guys

A 38 year old female with learning difficulties presented with concerns about the way she walks and how it wears out her shoes. No painful symptom.

The video (here - https://www.coachseye.com/v/Mcqc) is of her scissor gait and would suggest CP but she denies any Dx of CP and her support worker has no record of that either.

The patient reports that her gait has been like that "since I was born" obviously she means from a very young age. Her support worker suggest that it has become worse over the last ten years that she has worked with the patient.
Standard Root type medial rearfoot posted rigid orthoses have been fitted by NHS but these seem to have no effect on gait and the support worker reports that she thinks it makes it worse. I agree that without the orthoses her feet pronate less.

She has 'normal' foot and ankle alignment and RoMs. She has very lateral STJ axes both feet. Hamstrings tight - she can fully extend the knees but hip flexion rom is tight at 20dgs SLR.

In gait both feet have medial border foot strike and near max pronation in stance phase.
I thought that (CP not withstanding) this might be a compensation for very lateral STJ axes where the peroneals are activated to stop inversion sprains.

I tried Quadrastep OTC rigid orthoses with lateral f/foot posting but this made the pronation worse.

I plan to use orthoses, mobs and releases and stretching but my question is:

Would you guess that this is a CP gait and if not any ideas how you might address this with orthoses.

Regards Dave Smith

 

Hi Dave,

Asked the wife the P&O of the family

not a classic CP gait according to her, she did mention look at the strength of the muscles around the hip if you have not

 

IMO the orthoses will not support that heavy medial type gait in the wrong shoe.

If the shoe doesnt have enough structure and a good heel width to match, then there is nothing to support the orthoses.

You may also want to add a heel flare to the medial aspect on her existing footwear.

Any chance of a picture of the shoes on a bench, heels towards the camera, toes away side by side?

 

Hip abductor muscles very weak

Dave

 

Hi,

Just looking at the video I'd tend to agree with the above - my initial thoughts were low tone / poor co-ordination considering the learning difficulties. Unless of course there is any spasticity. Not an expert but see a fair bit of CP (orthotist...). Sounds like it could be difficult to modify with foot orthoses. Will be interested to hear how you get on.

Josh