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i have a interest in paed biomechanics and i have treated a few patients in the past with intoeing gait,one of the standard approaches to intoeing gait is the use of gait plates,A.Redmond wrote an article on the use of gait plates and how 14 out of 17 patients he had treated had reduced episodes of tripping ,what i want to know is,how the gait plate actually works what mechanical function is it based on this may sound like a daft question but then again if you dont ask you dont get i wait for your answers with great interest
thanks

See:
Effects of gait plates on the midtarsal joint in children
Gait plates for in-toe gait

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thanks for the two articles posted is there anything else out there on the use of gait plates

I have used quite a lot of gait plates in paediatrics over the years. If my primary concern is a transverse plane problem I will use a flat gait plate which I have the lab make for me from a template. I take a template from the shoe and mark the met heads and the apex of the 5th digit (for intoe). I will then draw on the template where i want the gait to finish - I usually finish just proximal to the 1st met head and at the apex of the 5th digit. I have the plate made from a subortholen material (usually multicolour so the child accepts it more readily). It is left uncovered and the only adjustment I may need to do is a minor grind to ensure it sits flat in the shoe. It is bevelled at the distal edge for comfort. the shoe must be very flexible as the aim is to change the break line of the shoe in gait. (Tax has a small section in his old text Podopaediatrics - if you haven't read that one). The shoe also needs to be very lightweight - this often means they are the inexpensive shoes!!! I have used them very successfully in the "jelly sandals" for girls that come in bright colours and have a heel counter but are very flexible!
if you are having frontal plane problems them I may combine them with a casted device in an attempt to obtain some frontal plane control but beware - if you are trying to effectively control moderate to severe pronation problems you are likely to increase the intoe and parents need to be aware of this. i will discuss of course the aim of my therapy and what is most important to address first!!
of course at the same time as a gait plate is used the underlying factors ( muscle tightness at hips etc ) also need to be addressed.
By the way i find that the cost of a flat gait plate is quite low and very effective.
All the best
cpcpod

thanks for the reply ,i myself use gait plates quite often ,but still find it difficult to locate research articles about the subject
wayne

Not a huge fan of gait plates as I am still havn't seen a enough research to show that changing the gait forces through little growing bones is appropriate and all too often I have seen them issued with disregard to the cause of the intoeing.

If you look at some of the main causes:

Intoe gait from the hip: Interal hip position due to "w" sitting and poor core strength, how will a gait plate change this? You need to re-educate the sitting position, improve core strength, stretch out the adductors and strengthen the abductors.

Intoe from the tibia: Osseous rotation, is this familial or is there a posture such as sitting or ball sleep that is inhibiting the bodies natural inclination to derotate the tibia during natural growth, how would a gait plate change this? Wouldn't a CRS/dennis browne bar and investigation into sitting and sleeping posture have more effect?

Intoe from metadductus: How would gait plate change this? If it is that bad then a surgical opinion should be sought, if not then should first port of call be protecting the foot from becoming a skew foot. If a flat gait plate was used wouldn't this hasten the process of the foot becoming skew by forcing the change in foot posture and placement.

I guess we really need to be clear in our diagnosis of what is causing and then logically think through what we arae treating and why, otherwise our gait plate becomes a bandaid solution, changing the appearance and not the cause.

Cheers
Cylie

Hi Wayneb,

I think that once you have eliminated the causes of intoeing outlined by Bug, there are a few left that are a result of compensating by avoidence for a "weak foot", one that would otherwise be grossly pronated. Another avoidence strategy can be the toe walker.

In this case a gait plate, which incorporates frontal plane axial momments may be helpful. Nevertheless, it needs to be well managed, and as mentioned by cpcpod shoes need to be very flexible. I only use these in pre schoolers as I think they are only a walking device and not suitable for running sports.

For the others not within my narrow category, I tend to use 2-5 extensions(reverse Morton's) on their devices, which do seem to improve angles also.

Cheers
Shane

thanks for your input much appreciated.I agree with you (bug) there is very little evidence out there the reason for me posting the question in the first place.However i am not saying that gait plates are the answer but what i am trying to achieve is to affect the biomechanical function of the legs at propulsion stage of gait by reversing the breakline of the shoe,whatever worth you put on anecdotal evidence it seems to work in about 50% of the patients i treat.I will only say this is a short term approach to the management of symptomatic intoeing gait as we are all aware the condition improves with time,if not aesthetically it will funtionally.Is there anybody out there who uses gait plates on a regular basis? would like to here your opinion

yhanks
wayne

the youngest age at which gait plates can be used for femoral antiversion? gina. When is the Denis Browne bars strongly indicated and age at which it is mostly affective and duration of use?

Is anyone able to answer these questions?

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Regards,
Dean

Hey all.

Have used gait plates for a few years with mixed success, some successes and some spectacular failiures.

The earliest i have ever used them was on a 6YO diplegic who had just come out of hip twisters. As a general rule however i find they work better in slightly older children .

I find the footwear is important, it needs to hold the foot down onto the orthotic firmly. As such i often use them in conjunction with piedros or other specialist footware.

I have also used them effectivly as a hybrid with a UCBL with a dorsal foldover.

As with all such things, you have to pick your patients.


Regards
Robert