The effectiveness of gait plates in controlling in-toeing symptoms in young children

Abstract

A range of patient-oriented and practitioner-oriented outcomes were used to evaluate the efficacy of "gait plate" shoe inlays in controlling symptoms associated with in-toeing in otherwise healthy children. For 18 in-toeing children, parents completed a preintervention questionnaire. Then, during randomized trials, foot placement angle was measured both with and without gait plate inlays in the children's footwear. After the children had worn the gait plates for 1 month, a simple questionnaire was used to rate parental satisfaction with a range of factors associated with control of symptoms. The use of gait plate inlays resulted in a small but statistically significant reduction in the amount of in-toeing as measured by foot placement angle. Gait plates reduced the reported frequency of tripping in 14 of the 18 cases. The reported parental satisfaction was high or very high in all but one case, suggesting that this intervention warrants further investigation as an alternative to "observational management" for symptomatic in-toeing.

Non-surgical management of a pediatric “intoed” gait pattern – a systematic review of the current best evidence

“…These five studies represent the current best available level of evidence in the non-surgical management of an intoed gait pattern in a pediatric population (level IV – case series). Of note, three studies reported specific subject inclusion and exclusion criteria for their cohorts, whilst only two studies further described the presence of the underlying etiologies of their intoeing cohort 3,7,14,20. A total of four different interventions were reported: a flexible leather counter splint, shoe modifications, gait plates, and an orthotic device with a gait plate extension.…”

“…This intoed gait pattern is one of the most common referrals made to a pediatric orthopedic specialist 1–6. Parental concern as to the aesthetics of the child’s gait pattern will primarily drive these referrals 3–5,7–11. Whilst some of these referrals will prove to be the result of a normal growth variant,2,9,14–19 some children will present with a symptomatic intoed gait pattern.…”

“…Whilst some of these referrals will prove to be the result of a normal growth variant,2,9,14–19 some children will present with a symptomatic intoed gait pattern. Symptoms commonly reported include frequently tripping, clumsiness during physical activities, and fatigue like pains 3,7,13,18,19. Parents may also be concerned with the possibility of any long term effects on their child’s development.…”

“…The degree of intoeing or outtoeing can be determined using the Foot Progression Angle (FPA) 2,3,7,17,24,27–31. This angle is formed by the line of progression (direction of gait) and the bisection of the person’s foot print.…”

“…A measurement in excess of 2 SDs (standard deviations) is said to be indicative of an abnormal FPA 3,7,29. Whilst a measurement outside these values should suggest an abnormal gait pattern, there is no indication as to what degree of intoeing would constitute a pathological outcome.…”