The limping child   dr. ibrahim rakha
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The limping child dr. ibrahim rakha

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The limping child   dr. ibrahim rakha The limping child dr. ibrahim rakha Presentation Transcript

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