The limping child dr. ibrahim rakha

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The limping child dr. ibrahim rakha

  1. 1. LIMPING CHILD Prof. Dr. Ibrahim Rakha Professor and Chairman, Department of Orthopedics Faculty of Medicine, Suez Canal University
  2. 2. OBJECTIVES <ul><li>(1) To understand the physiology of normal walking. </li></ul><ul><li>(2) To be able to analyze the determining factors of normal walking. </li></ul><ul><li>(3) To be able to assess a child with abnormal gait. </li></ul><ul><li>(4) To know the causes of limping. </li></ul><ul><li>(5) To diagnose and put a plan of management of a case of limping child. </li></ul>
  3. 3. <ul><li>The primary objective of human locomotion is translation of the body from one place to another. </li></ul><ul><li>Gait is a dynamic repetitive act affected by: </li></ul><ul><li>Trunk sway </li></ul><ul><li>Arm swing </li></ul><ul><li>Head motion </li></ul><ul><li>Normal walking is relatively effortless with a minimum expenditure of energy. </li></ul>
  4. 4. <ul><li>GAIT CYCLE: </li></ul><ul><li>From heel strikes the ground and next heel strike of the same limp. It consists of two phases: </li></ul><ul><li>1- stance 2- swing </li></ul><ul><li>STRIDE LENGTH: </li></ul><ul><li>The distance traveled in the same time span as gait cycle. </li></ul><ul><li>STEP LENGTH : </li></ul><ul><li>From H.S of one foot to the H.S of the opposite foot </li></ul><ul><li>CADENCE : </li></ul><ul><li>The number of steps per minute </li></ul><ul><li>WALKING VELOCITY: </li></ul><ul><li>Speed of movement in one duration in cmsec. </li></ul>
  5. 5. Gait Cycle <ul><li>Stance Phase : </li></ul><ul><li>Swing Phase </li></ul>E.D.S M.S T.S L.D.S 12% 23% 15% 12% H.S 62% 0 I.S M.S T.S 16% 9% 18% 100%
  6. 6. Factors determining the normal gait : <ul><li>Pelvic rotation : </li></ul><ul><li>4 degrees forward swing limb </li></ul><ul><li>4 degrees backward stance limb </li></ul><ul><li>Pelvic tilt in horizontal plane : </li></ul><ul><li>Knee flexion after heel strike in stance phase </li></ul>
  7. 7. <ul><li>Foot and Ankle motion </li></ul><ul><li>Knee motion </li></ul><ul><li>Lateral displacement of the pelvis </li></ul><ul><li>limb length equality. </li></ul>
  8. 8. Muscle action in the gait : <ul><li>To Stabilize isometric contraction (same length) </li></ul><ul><li>To Accelerate concentric contraction (shorten) </li></ul><ul><li>To Decelerate eccentric contraction (longer) </li></ul><ul><li>-The development of mature gait depends upon maturation of C.N.S(postural ,labyrinthine and rightining reflexes ). </li></ul><ul><li>-The adult pattern of gait develops between 3-5 years of age. </li></ul>
  9. 9. Assessment of patient with gait abnormality <ul><li>(1) Examination: </li></ul><ul><li>walking on feet ,toes and heel </li></ul><ul><li>Run </li></ul><ul><li>Stair climbing </li></ul><ul><li>Tandems walk </li></ul><ul><li>walk forward and backward 6 steps with eye open and eye closed </li></ul><ul><li>(2) Measurements for limb length (discrepancy) </li></ul><ul><li>(3)Examination for deformities and joint stiffness </li></ul>
  10. 10. <ul><li>(4) Assessment of muscle power </li></ul><ul><li>(5)Neurological examination </li></ul><ul><li>(6) Radiological assessment </li></ul><ul><li>(7) Electro-Diagnosis </li></ul>
  11. 11. PATHOLOGICAL GAIT
  12. 12. Causes : <ul><li>(1) Muscle weakness:(source of motion ) </li></ul><ul><li>Glut.Med (Hip Abd) unilateral (lurching) </li></ul><ul><li>bilateral (wadding) </li></ul><ul><li>Glut .max (hyperextension of the trunk) </li></ul><ul><li>Quadriceps muscles locking </li></ul><ul><li>paralysis giving way </li></ul><ul><li>support his knee with </li></ul><ul><li>his hand on the thigh </li></ul><ul><li>Gastrocenimus muscles responsible for final propulsion in push off portion of stance phase </li></ul>
  13. 13. <ul><li>(2) Deformities of bones and joints (Articulated lever ) </li></ul><ul><li>Ankylosis of joint(hip or knee ) </li></ul><ul><li>Deformities of B&J genuvarum ,valgum,hip flexion </li></ul><ul><li>painful affection of bone and joint </li></ul><ul><li>(antalgic gait : decreased stance phase on the affected limb) </li></ul><ul><li>congenital dislocation of hip Trendlenburg gait </li></ul>
  14. 14. <ul><li>(3) Neurological disorders </li></ul><ul><li>“ disturbed awareness of the need for action and control of motion “ </li></ul><ul><li>spastic gait hypertonicity -hyperreflexia </li></ul><ul><li>ataxic gait spinal ,cerebellar ,combined </li></ul><ul><li>dystrophic gait myopathy and muscle dystrophy </li></ul>

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