Case sharing 2: A case study of gait analysis in a cerebral palsy child , shared by Jinan Children's Hospital
Basic Information: Cerebral Palsy Girl, 4 years old
Gait Analysis Tool: Dynamic gait and posture analysis system
Under Gait Assessment...
The naked eye observation gives us a rough idea. It's quite obvious to see the swaying of her balance from side to side. This is an indication of her unstable weight transfer. Furthermore, her body tilts significantly to the right. In theory, this could suggest that the right leg is shorter than the left leg.
Now let's look at her gait report ，there is an AI generated conclusion:
Here, the AI conclusion directly points out the issue of weight transfer, indicating that the left side bears weight for a longer period than the right side.
And then there's a slight forefoot landing on the right foot, which is what we call a tiptoe gait.
The fact that the force on the sole is concentrated on the medial side during the landing and midstance phases indicates there's eversion.
Both left and right sides exhibit insufficient push-off extension, with the right side having a slightly smaller angle of extension.
The final issue detected by AI is that during the swing phase, there is reduced dorsiflexion velocity of the right foot. It could be due to insufficient strength in her right tibialis anterior muscle.
Next, let's take a look at the intuitive data:
We observe a difference on swing phase between both sides, with a nearly 4% variation between the left and right feet.The asymmetry between the left and right sides is quite noticeable.
From the heel touching the ground to the heel leaving the ground ,which is called the foot-flat phase.The right foot-flat phase is longer than the left.
The right side may have knee hyperextension.
The curve of the right foot at the moment of landing is below the gray band, indicating that the angle of landing of the right foot is less than the normal value. At this time, there is insufficient dorsiflexion of the right foot.
Going further down, from a frontal plane perspective, both of her feet are in eversion throughout the entire gait cycle.Because both the blue and red curves are below the normal gray area.
From a horizontal plane perspective, her feet are overall slightly abducted, which is called "toeing out," and her right foot's toeing out is more pronounced.
The foot progression angle is 11.7°, which is significantly beyond the normal range of 3.98° to 8.59°.
It's important to note that the angle difference in her foot progression angles has reached nearly 8°. Generally, based on experience, differences exceeding 6° are often accompanied by scoliosis.
Let's take another look at the foot landing trajectory:
The red line represents the left foot landing, starting from a position close to the heel, while the blue line represents the right foot landing, starting from a position closer to the midfoot.The right foot lands forward, indicating a tiptoe gait.
Both feet's rolling trajectories are biased towards the medial side of the foot, further indicating the situation of eversion.
The significant color difference in the landing points of both feet indicates varying impact forces with each step, sometimes high and sometimes low. Particularly, the colors of the landing points for the right foot range from red to yellow to green, indicating a more unstable gait during walking.
Tha's a brief introduction of this pediatric gait analysis case.
Conclusion:
Poor left-right symmetry, unbalanced weight distribution, and both feet pronated.Significant toeing-out of the right foot and insufficient dorsiflexion.
Speculation:
Right leg is shorter and exhibits knee hyperextension, along with scoliosis and uneven shoulders.
Intervention Recommendations:
Further confirmation of leg length discrepancy, whether it's structural or functional. If it's structural, custom orthotic insoles are recommended to prevent further progression of scoliosis.Simultaneously addressing the eversion of the feet.
Core training along with dorsiflexion exercises for the right foot to strengthen muscle.
Expert testimony：
The most convenient aspect is that children can freely walk for one minute, with both visual observation of their gait and precise measurements from instruments being conducted simultaneously.