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Would you be concerned about her gait?


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#1 CPSTAnne

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Posted 12 March 2017 - 11:39 PM

These were taken today. From a practical standpoint, she is really hard on shoes! But beyond that, is this a problem?

 

https://youtu.be/aIEqChjquKE

 

https://youtu.be/ZCh6PdwhT9I

 

https://youtu.be/GOKxz8yKpbo



#2 sbgrace

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Posted 12 March 2017 - 11:49 PM

What happens barefoot? If that's her typical gait, and not just those shoes or occasional, I would have an evaluation. My son had PT and orthotics (different issues--but I think this needs eval similarly).


Edited by sbgrace, 12 March 2017 - 11:53 PM.

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#3 Paige

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Posted 12 March 2017 - 11:51 PM

Absolutely! 100%, no question, yes! 

 

How long has she been walking like that?

 

Does she have any tightness or hypermobility? Check her hamstrings and her heel cords. It looks like one side may be worse, which makes it easier to check for tightness.

 

Does she tire easily or complain of pain? Trip and fall?

 

Can she hop on one foot, both sides? 

 

I agree- if she's fine barefoot or in other shoes, it could be no big deal.

 

But, if it's occasionally, but the occasionally is consistently when she's tired or at the end of the day, I'd still be concerned. 

 

 

 

 


Edited by Paige, 12 March 2017 - 11:54 PM.

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#4 lovelearnandlive

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Posted 12 March 2017 - 11:58 PM

I'm not an expert, but I had a daughter that pronated when she walked and this looks like a more extreme version of what she did. First thing I would do is get rid of those unstructured, floppy boots and get her in a pair of good, well-fitting walking shoes with arch supports and orthotics if needed. She needs her arches held up and her feet and legs better aligned.

In my dd's case, she had very weak hip rotators and a lot of hip flexibility. And very high arches but not enough strength in her feet. A physical therapist gave her strengthening exercises, which helped. She also studies ballet, which has made a huge difference in the strength of her hips and feet. Three years later and she doesn't pronate at all anymore. I have yet to allow her to wear Ugg-type boots again though. ;)
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#5 Moved On

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Posted 13 March 2017 - 12:22 AM

What she is wearing is too large for her feet. She may be walking like that just to keep them from sliding off. If she routinely wears shoes that don't fit properly, it could be creating a problem even if there isn't one.

Good arch support is important. I also check my kids' shoes regularly. One thumb size (turned sideways) from the big toe is what I buy them. If it is starting to get below half a thumb, it is time for new shoes. I seem to remember reading it in one of the *What to Expect...* books and have followed it throughout the years.

You need to put proper fitting shoes on her feet before determining if there is cause for concern. You can also get a precautionary eval regardless.

Edited by Canadian Mom of 2, 13 March 2017 - 12:32 AM.

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#6 NorthwestMom

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Posted 13 March 2017 - 12:36 AM

I would definitely have her checked by a specialist.


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#7 CPSTAnne

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Posted 13 March 2017 - 12:47 AM

What happens barefoot? If that's her typical gait, and not just those shoes or occasional, I would have an evaluation. My son had PT and orthotics (different issues--but I think this needs eval similarly).

It's so much more noticable in these boots, but I do still see it barefoot. I've never stopped and really analyzed though, so I will record her tomorrow barefoot to compare 

 

Absolutely! 100%, no question, yes! 

 

How long has she been walking like that?

 

Does she have any tightness or hypermobility? Check her hamstrings and her heel cords. It looks like one side may be worse, which makes it easier to check for tightness.

 

Does she tire easily or complain of pain? Trip and fall?

 

Can she hop on one foot, both sides? 

 

I agree- if she's fine barefoot or in other shoes, it could be no big deal.

 

But, if it's occasionally, but the occasionally is consistently when she's tired or at the end of the day, I'd still be concerned. 

I don't even know how to check for those things! She does sometimes tire easily, which always seems odd as she is a seeker and seems to have endless energy. She is very uncoordinated, she *could* hop on one foot, but she'll likely fall over after a couple hops. I'll have her do that tomorrow, too. 

 

I'm not an expert, but I had a daughter that pronated when she walked and this looks like a more extreme version of what she did. First thing I would do is get rid of those unstructured, floppy boots and get her in a pair of good, well-fitting walking shoes with arch supports and orthotics if needed. She needs her arches held up and her feet and legs better aligned.

In my dd's case, she had very weak hip rotators and a lot of hip flexibility. And very high arches but not enough strength in her feet. A physical therapist gave her strengthening exercises, which helped. She also studies ballet, which has made a huge difference in the strength of her hips and feet. Three years later and she doesn't pronate at all anymore. I have yet to allow her to wear Ugg-type boots again though. ;)

It's actually the plan to go shoe shopping tomorrow so I'll be sure she gets something meeting those needs. 

 

What she is wearing is too large for her feet. She may be walking like that just to keep them from sliding off. If she routinely wears shoes that don't fit properly, it could be creating a problem even if there isn't one.

Good arch support is important. I also check my kids' shoes regularly. One thumb size (turned sideways) from the big toe is what I buy them. If it is starting to get below half a thumb, it is time for new shoes. I seem to remember reading it in one of the *What to Expect...* books and have followed it throughout the years.

You need to put proper fitting shoes on her feet before determining if there is cause for concern. You can also get a precautionary eval regardless.

These actually fit her quite well when she first got them. Using them like this all winter has caused them to get very stretched and floppy. The style may still be bad for her if it causes this problem to be worse, but it's there even in sneakers. After we get new shoes tomorrow (which was already the plan, to prepare for an upcoming trip), I'll compare her walk in those to this. 



#8 Moved On

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Posted 13 March 2017 - 02:04 AM

I was thinking more along the lines of, she's a little girl, perhaps she likes playing dress up and wearing shoes that are not hers ;)

Anne, if your gut is telling you there may be cause for concern, it might be a good idea to follow it.

#9 SKL

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Posted 13 March 2017 - 07:39 AM

Let's see it without ill-fitting boots.  :)

 


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#10 Paige

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Posted 13 March 2017 - 09:20 AM

 

I don't even know how to check for those things! She does sometimes tire easily, which always seems odd as she is a seeker and seems to have endless energy. She is very uncoordinated, she *could* hop on one foot, but she'll likely fall over after a couple hops. I'll have her do that tomorrow, too. 

 

 

 

Have her lay on her back and bend one knee, and have the other straight. Then, see how far you can extend the bent leg and then do it again with the opposite leg. She should be able to extend both legs about equally. If she stretches regularly in some kind of athletics, at 4, she should be pretty flexible and just about able to extend straight up. If she doesn't stretch often, I'd want to see at least about a 75 degree or more angle on both sides. You may have to put a hand on the straight leg to keep it from coming up with it's partner. 

 

For the heel cords, have her lay down, bend a knee, and see how far you can push her foot up towards the ceiling. She should be able to go a little past 90 degrees on both feet. Ask her to lift her foot up and do the same thing by herself. Is there a big difference between what you can do and what she can do? There will be some difference, but she still should be able to go a little past neutral (flat footed/90 degrees) on her own power. 

 

Then check to see what her range of motion is in all directions for each foot. I'm not sure what you want here, but I know she should be about equal in both feet and she should be able to voluntarily move in each direction.

 

I'd also have her feet hanging off a chair and check her reflexes. Tap her knee and she should kick once. You don't want to see no kicks (what my DD does now) or multiple kicks (what she did prior to surgeries). 

 

I'd still take her to the pediatrician, but if she fails any of the above tests, I'd insist on a referral to an orthopedist or neurologist. Which one to see first doesn't really matter. 

 

An improper gait can lead to a lot of muscle, tendon, and joint damage and some of it is irreversible. I wouldn't let her walk like that for longer than necessary. I don't mean to be alarmist, but it's better to be safe. 

 

This gives some pictures for the stretching I tried to describe:

http://calder.med.mi...ntis/lower.html


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#11 CPSTAnne

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Posted 13 March 2017 - 10:42 AM

I promise those boots really do fit, in fact she's probably close to outgrowing them. The sides are only so floppy because of her stepping on them like this all winter. They were pretty solid at first. 

 

I had her wear Sketchers today and I saw it in those, too. It wasn't as obvious as I figured it wouldn't be, but there. I didn't have a chance to take a video; we were running soo late. Thank you, time change. 

 

Paige - This is actually my 8yo though she often sounds more like a 4yo! She is in both dance and tumbling and they do stretch there. I will try those things with her tonight and see how she does. 



#12 CPSTAnne

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Posted 13 March 2017 - 10:52 AM

This is from december when they still had more structure to them. 

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#13 Paige

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Posted 13 March 2017 - 10:54 AM

I didn't have the volume on for the videos, so I apologize to your 8yo who probably doesn't appreciate being mistaken for her little sister. I just assumed it was the little one because there had been no intervention yet.

 

I think my DD (9) has the same boots. They are a little floppy on her too.



#14 lovelearnandlive

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Posted 13 March 2017 - 11:03 AM

This is from december when they still had more structure to them.


Yes, my dd destroyed hers as well due to walking incorrectly in them.

As a test, you can have your dd stand barefoot on a hard floor and look at her heels from behind. Does her achilles look like it curves near her heel? If so, have her lift her arches off the floor until the tendon looks nice and straight. My guess is that she will have a significant space under her arch when she straightens things out.

I took dd to a running shoe store where they actually make custom inserts while you wait. They were pricey but less expensive than getting orthotics, and they did the trick. However, the shoes don't solve the underlying problem, which is a muscle weakness. But they will align things properly while she works on getting stronger.
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#15 CPSTAnne

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Posted 13 March 2017 - 11:04 AM

We've been pretty focused on a lot of other issues with her so this has been more something in the back of my mind that I've just wondered about. She sees an OT regularly and I did mention her gait once to her, but she said she was unable to address it and we'd have to see a PT if we wanted that evaluated. But it was at the end of a session as we were leaving. And it's definitely less pronounced barefoot (I'm going through all the old videos I can find) and she is barefoot from the second she steps into the OT gym. She hates shoes. 

 

And she wouldn't mind being mistaken for little sister, actually. She acts more 4 than 8 and thinks of herself as 4. Large maturity gap. PS was supposed to help with that this year and it has a little bit, but not quite as much as we'd hoped. 



#16 Paige

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Posted 13 March 2017 - 11:23 AM

I would not let a PT evaluate her. Take her to an orthopedist or neurologist first and they can refer to the PT with guidelines and directions. I say this as someone whose DD fell through the cracks and who has had terrible advice from PTs. They are good at therapy and strengthening but not at diagnosis and treatment. Let the doctor decide if she needs orthotics and what type. 


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#17 prairiewindmomma

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Posted 13 March 2017 - 11:47 AM

If she has similar issues barefoot or in supportive tennis shoes, I'd be asking to see neuro or a physiatrist.  She's got multiple issues going on with her gait.  I agree with the others who said PT is not where to go on this one.  You want someone with a broad view.

 

I took away my dd's floppy boots, and we went back to Stride Rites. When you've got stuff going on, you need to be careful with shoes.


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#18 Moved On

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Posted 13 March 2017 - 01:16 PM

This:

I would not let a PT evaluate her. Take her to an orthopedist or neurologist first and they can refer to the PT with guidelines and directions... Let the doctor decide if she needs orthotics and what type.


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#19 Moved On

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Posted 13 March 2017 - 01:20 PM

This is from december when they still had more structure to them.


There's definitely a huge difference in the picture. The fact that she wears out shoes a certain way can also be a sign that there's a problem.

Edited by Canadian Mom of 2, 13 March 2017 - 01:28 PM.

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#20 Moved On

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Posted 13 March 2017 - 01:27 PM

Anne, there's nothing wrong with a little girl wearing pretty shoes or boots that she likes. It's the frequency that you need to look at.
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#21 Alessandra

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Posted 13 March 2017 - 01:30 PM

I would not let a PT evaluate her. Take her to an orthopedist or neurologist first and they can refer to the PT with guidelines and directions. I say this as someone whose DD fell through the cracks and who has had terrible advice from PTs. They are good at therapy and strengthening but not at diagnosis and treatment. Let the doctor decide if she needs orthotics and what type.


I love PTs, but have to agree with this. I would get to an orthopedist, either directly or via your primary. The orthopedist will be able to suggest treatment.

My kids had custom orthotics for many years when they were small, and were so helpful. Our plan at the time didn't cover custom orthotics; they were tremendously expensive, and of course young children need new orthotics when their feet grow. I hated the expense, but I am now so glad we did it.

Not meaning to say custom orthotics are the only solution -- just that it is wise to follow advice from a good doctor.
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#22 CPSTAnne

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Posted 13 March 2017 - 01:50 PM

Around here it seems that most specialists require a referral from the primary doctor. I will call her pediatrician and get her in to an ortho. I love her pediatrician and she knows us well, so I might not even need to take her in, just ask. 

 

I'm anxious for her to be home from school now so I can check for some of the things mentioned in this thread and get some good simple video of her in other shoes and barefoot. 

 

So is it just something supportive in general I want to look for in a shoe? High vs low on the ankle? Pronounced arch? She is picky with shoes and hates them generally, so I have a feeling she will gravitate to exactly the stuff she shouldn't wear and fight the stuff she should. 

 

 

There's definitely a huge difference in the picture. The fact that she wears out shoes a certain way can also be a sign that there's a problem.

Yes all of her shoes wear out so much faster than her sister's do and not uniformly. So do DH's, he is very hard on shoes. 

 

Anne, there's nothing wrong with a little girl wearing pretty shoes or boots that she likes. It's the frequency that you need to look at.

She's worn those boots almost every day she's left the house since she got them around Nov. :/ :(  I didn't realize it could be an issue. I was so careful with shoes when she was a toddler; I only got her stride rite and pedipeds. Once she hit about 4 and we added another kid, I stopped paying attention to shoes and let her pick out whatever. I hope we haven't inadvertently made it much worse. 



#23 Moved On

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Posted 13 March 2017 - 02:01 PM

Anne, :grouphug: don't beat yourself up. Get the referral, take her in, and let the doctor recommend shoes. Orthopedists were what was recommended back home (Europe). It *can* be addressed. That’s what you need to look at.
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#24 Paige

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Posted 13 March 2017 - 02:03 PM

Don't bother buying new shoes until you see an ortho. If she needs inserts or orthotics, you'll want to buy shoes with those in mind and maybe take them with you to try them on. In general, though, you want firm ankle support. Pedipeds are awesome! They also have inserts that can be removed if you need to replace them. We haven't had luck with New Balance, but I know lots of people recommend them too.
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#25 prairiewindmomma

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Posted 13 March 2017 - 02:04 PM

Our physiatrist, who did dd's orthotics, was adamant about Stride Rite tennis shoes (although  a couple of Euro brands were also acceptable).  Essentially, the shoe needs to be biomechanically sound--arch support, stiff heel counter, and a flexible enough sole to allow for MPJ dorsiflexion.  So, not all Stride Rites will fit that criteria (I am thinking of my dd's silver sparkle flats)--but it's the shoe that they should be in the vast majority of the time.

 

You can look for APMA seals of approval if you need a bigger brand selection to choose from.


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#26 Paige

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Posted 13 March 2017 - 02:05 PM

Also, her shoes did not cause the issue and if she's 8 and nobody has noticed, it's probably not too serious.
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#27 prairiewindmomma

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Posted 13 March 2017 - 02:13 PM

I just read Paige's post---she's right, if you can get in soon (our physiatrist has a 6-12 month wait so I didn't think of it), I'd wait to buy shoes until you can get her evaluated to see if she needs AFOs/DAFOs.  We had to size up to get her orthotics to fit correctly.


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#28 Moved On

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Posted 13 March 2017 - 02:40 PM

While shoes won't necessarily be the cause of a problem, they can exacerbate it. Just stating a fact that any specialist will confirm. Also, the way someone wears out shoes, will be another indication of an existing problem.
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#29 Plink

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Posted 13 March 2017 - 03:08 PM

Yes, she needs to be seen.  That is not the gait of a typical 8yo, regardless of the floppy shoes.  I'd talk with your pediatrician and get their opinion about where to start.  They will be able to asses the basics of whether it is musculoskeletal, neurological, or some other issue, and give you a referral to a specialist.

 

At only 8 there is plenty of time for remediation.  She is still young and has a lot of growing left to do.


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#30 Moved On

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Posted 13 March 2017 - 03:51 PM

Very good points!

...I'd talk with your pediatrician and get their opinion about where to start. They will be able to asses the basics of whether it is musculoskeletal, neurological, or some other issue, and give you a referral to a specialist.

At only 8 there is plenty of time for remediation. She is still young and has a lot of growing left to do.



#31 Moved On

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Posted 13 March 2017 - 05:24 PM

There's some evidence now that going barefoot as much as possible is very beneficial and can even help correct certain problems. That’s another thing you could look into, at least for when she is at home. My two have always avoided slippers, much to my chagrin (maybe that was a good thing after all), so they don't wear anything in the house. I do get them to wear socks, but that's just a personal thing though.

Edited by Canadian Mom of 2, 13 March 2017 - 05:27 PM.

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#32 CPSTAnne

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Posted 13 March 2017 - 05:59 PM

I have a call in to her pediatrician and am just waiting to hear back. They're usually pretty swamped on Monday so I probably won't get a call until tomorrow. We'll hold off on shoes for another day at least until we get an idea of how far out the specialist will be, but she needs something soon. We go to Disneyland the first week of April and her current options that fit are those boots and a very low ankle pair of sketchers. Those would work if she needs to but they're quite worn out and do need replaced. And I don't want her to go in brand new shoes, she needs a couple weeks to work them in. 

 

We actually have noticed it for a long time, I guess we just didn't see it as a serious issue. More like a quirk or preference but not a problem. Maybe it's that it's become more pronounced with those dang boots that we finally started seriously questioning if we needed to *do* something about it. 

 

She is barefoot as much as possible. She hates socks as much as she does shoes. When she gets home both are kicked off so quickly that I have had trouble opening the door coming in right behind her because they are right. there. She usually doesn't wear them outside but I do insist for bike riding. She takes them off in the car and any destination she's able. 

 

 



#33 Paige

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Posted 13 March 2017 - 06:37 PM

 

We actually have noticed it for a long time, I guess we just didn't see it as a serious issue. More like a quirk or preference but not a problem. 

 

 

 

We were the same with my DD. She was a lot younger than yours, but she was so functional that I never dreamed her occasionally quirky gait was a problem. Her pediatrician felt terrible! She had been seeing her for years and never suspected anything either, but once we pointed it out, it was obvious to her. 



#34 OhElizabeth

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Posted 19 March 2017 - 12:32 PM

Hey, did you ever get this sorted out or get a referral? Just so your comment about going to Disneyland soon. If you aren't getting seen to get some options before then, I would take her to Finish Line (or somehwere that fits kids and sells good shoes) and have them add inserts. That's what I do with my ds. Definitely would not take her to Disneyland in those boots. Her knees are pronating and that's a lot of walking to do in improper footwear.

 

If the weather is nice, she could have a pair of sandals that have arch supports in them. Does Keens make them for kids? Do you have stores (REI, whatever) that sell shoes like that?