Orthotic Devices with Out-toeing Wedge as Treatment for In-toed Gait in Children

Munuera, Pedro V.; Castillo, José Manuel; Domínguez, Gabriel Ernesto; Lafuente, Guillermo

doi:10.7547/1000472

Cited by 11 publications

(17 citation statements)

References 6 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…“An out-toeing wedge consisting of a distal extension of the material of the orthotic device that selectively overshoots the metatarsophalangeal articular line of the external rays and ends in a point in the subdigital space of the fifth toe.”20…”

Section: Resultsmentioning

confidence: 99%

“…Only two of the utilized outcome measures have psychometric properties published for their use; the questionnaires used by Redmond and the barefoot FPA method utilized within the Munuera et al report 3,20…”

Section: Resultsmentioning

confidence: 99%

“…Although this critical appraisal tool does not assign a score, it is evident that the Lanier and Knittle and Staheli studies performed poorly in comparison to the other three studies 3,20. None of the studies had long term follow-up, with most of the studies reporting the immediate effect of the devices being trialled.…”

Section: Resultsmentioning

confidence: 99%

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

Uden¹,

Kumar²

2012

JMDH

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BackgroundAn intoed gait pattern is one of the most common referrals for children to an orthopedic consultation. Parental concern as to the aesthetics of the child’s gait pattern and/or its symptomatic nature will primarily drive these referrals during a child’s early developmental years. Whilst some of these referrals prove to be the result of a normal growth variant, some children will present with a symptomatic intoed gait pattern. Various treatments, both conservative and surgical, have been proposed including: braces, wedges, stretches and exercises, shoe modifications, and surgical procedures. However, which treatments are effective and justified in the management of this condition is not clear within the literature. The aim of this systematic review was to therefore identify and critique the best available evidence for the non-surgical management of an intoed gait pattern in a pediatric population.MethodA systematic review was conducted of which only experimental studies investigating a management option for an intoeing gait pattern were included. Studies needed to be written in English, pertaining to a human pediatric population, and published within a peer reviewed journal. Electronic databases were searched: Ovid (Medline), EMBASE, AMED, PubMed, SportDiscus, CINAHL, and Cochrane Library. The National Health and Medical Research Council’s designation of levels of hierarchy and the Critical Appraisal Skills Programme cohort studies critical appraisal tool were used.ResultsFive level IV studies were found. The studies were of varied quality and with mixed results. Gait plates, physiologic/standardized shoes, and orthotic devices (with gate plate extension) were shown to produce a statistically significant improvement to an intoed gait pattern. Shoe wedges, torqheels, and a leather counter splint were not able to reduce an intoed gait pattern.ConclusionThere is limited evidence to inform the non-surgical management of a pediatric intoed gait pattern. The body of evidence that does exist is small (n = 5) and of varied quality, which means recommendations arising from this evidence base should be interpreted with caution. There is generally weak evidence that suggests that gait plates and orthotic devices with a gait plate extension may assist in the management of a pediatric intoed gait pattern.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

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

Uden¹,

Kumar²

2012

JMDH

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“…Although in-toeing gait usually corrects itself before 8 years of age [5], this condition sometimes produces functional problems such as frequent tripping. In addition, the long-term effect of intoeing gait pattern such as patella-femoral pathology, hip joint arthrosis, and patella instability has been cited within the literature [6]. …”

Section: Introductionmentioning

confidence: 99%

Therapeutic Effect of Microcurrent Therapy in Children With In-toeing Gait Caused by Increased Femoral Anteversion: A Pilot Study

et al. 2017

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ObjectiveTo investigate the efficacy of portable microcurrent therapy device (PMTD) of the hip internal rotators in the treatment of in-toeing gait caused by increased femoral anteversion in children over 8 years of age.MethodsEleven children (22 legs; 4 boys and 7 girls; mean age, 10.4±1.6 years) with in-toeing gait caused by increased femoral anteversion were included in the present study. All children received 60 minutes of PMTD (intensity, 25 µA; frequency, 8 Hz) applied to the hip internal rotators daily for 4 weeks. Hip internal rotation (IR) angle, external rotation (ER) angle, and midmalleolar-second toe angle (MSTA) measurement during stance phase at transverse plane and Family Satisfaction Questionnaire, frequency of tripping and fatigue like pains about the PMTD were performed before treatment and at 4 weeks after initial PMTD treatment. Paired t-test and Fisher exact test were used for statistical analysis.ResultsHip IR/ER/MSTA was 70.3°±5.4°/20.1°±5.5°/–11.4°±2.7°, and 55.7°±7.8°/33.6°±8.2°/–2.6°±3.8° before treatment and at 4 weeks after initial PMTD treatment, respectively (p<0.01). Ten of 11 (91%) children's family stated that they were generally satisfied with the PMTD treatment. The frequency of tripping and fatigue like pains was significantly lower at 4 weeks after PMTD treatment (p<0.05). Excellent inter-rater and intra-rater reliability was observed for repeated MSTA measurements between the examiners (k=0.91–0.96 and k=0.93–0.99), respectively.ConclusionPMTD of the hip internal rotators can be effective in improving the gait pattern of children with in-toeing gait caused by increased femoral anteversion.

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Zooltherapie bij kinderen met geëndoroteerd gangpatroon

Neerven¹

2011

PODOSOPHIA

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Orthotic Devices with Out-toeing Wedge as Treatment for In-toed Gait in Children

Abstract: Orthotic devices with out-toeing wedge combined with correctly fitting shoes, as well as shoes alone, are useful tools in the treatment of in-toed gait in children.

Cited by 11 publications

References 6 publications

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

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

Therapeutic Effect of Microcurrent Therapy in Children With In-toeing Gait Caused by Increased Femoral Anteversion: A Pilot Study

Zooltherapie bij kinderen met geëndoroteerd gangpatroon

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Orthotic Devices with Out-toeing Wedge as Treatment for In-toed Gait in Children

Abstract: Orthotic devices with out-toeing wedge combined with correctly fitting shoes, as well as shoes alone, are useful tools in the treatment of in-toed gait in children.

Cited by 11 publications

References 6 publications

Non-surgical management of a pediatric &ldquo;intoed&rdquo; gait pattern &ndash; a systematic review of the current best evidence

Non-surgical management of a pediatric &ldquo;intoed&rdquo; gait pattern &ndash; a systematic review of the current best evidence

Therapeutic Effect of Microcurrent Therapy in Children With In-toeing Gait Caused by Increased Femoral Anteversion: A Pilot Study

Zooltherapie bij kinderen met geëndoroteerd gangpatroon

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Product

Resources

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

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