The limping child dr. ibrahim rakha
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Transcript of The limping child dr. ibrahim rakha
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LIMPING CHILD
Prof. Dr. Ibrahim Rakha
Professor and Chairman, Department of Orthopedics
Faculty of Medicine, Suez Canal University
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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.
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• 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.
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• 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 cm\sec.
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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%
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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
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• Foot and Ankle motion• Knee motion• Lateral displacement of the pelvis• limb length equality.
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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.
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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
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(4) Assessment of muscle power
(5)Neurological examination
(6) Radiological assessment
(7) Electro-Diagnosis
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PATHOLOGICAL GAIT
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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
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(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
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(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
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