Variations in normal gait development

Johnston, L; Eastwood, Deborah M.; Jacobs, Benjamin

doi:10.1016/j.paed.2014.03.006

Cited by 13 publications

(11 citation statements)

References 2 publications

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“…Independent management rates of up to 80% of patients with musculoskeletal complaints (Mir et al, ), and 94% of normal variant patients (Belthur, Clegg, & Strange, ; Lipscombe, Saville, James, & Bruce, ; Mir et al, ) have been demonstrated. Normal variants or physiological referrals (Molony, Heffernan, Dodds, & McCormack, ; Moraleda & Castellote, ) are identified in the literature as conditions that resolve spontaneously with the normal growth and development of the child, and do not require treatment or intervention (Johnston, Eastwood, & Jacobs, ; Jones, Khandekar, & Tolessa, ; Staheli, ). They are typically patients with flat feet, in‐toeing, out‐toeing and knock knees/bow‐legs.…”

Section: Introductionmentioning

confidence: 99%

An evaluation of diagnostic agreement rates between advanced practice physiotherapists and paediatric orthopaedic consultants for children with musculoskeletal complaints

Mir

O’Sullivan

Lennon

et al. 2018

Musculoskeletal Care

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This was the first study to evaluate diagnostic agreement rates between APPs and orthopaedic consultants, the appropriateness of onward referral by APPs and the SCR for paediatric musculoskeletal patients referred from an APP clinic. Good to excellent diagnostic agreement was observed for routine elective paediatric orthopaedic patients, in tandem with agreement levels reported in the adult literature. The study demonstrates that APPs are clinically effective in the diagnosis and onward referral of paediatric orthopaedic patients in a triage setting.

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Section: Introductionmentioning

confidence: 99%

An evaluation of diagnostic agreement rates between advanced practice physiotherapists and paediatric orthopaedic consultants for children with musculoskeletal complaints

Mir

O’Sullivan

Lennon

et al. 2018

Musculoskeletal Care

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“…These conditions are called “normal or physiological variants” and resolve spontaneously with growth and development. Specialist intervention and overinvestigation should be avoided [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

The efficacy of an extended scope physiotherapy clinic in paediatric orthopaedics

Mir

Cooney

O’Sullivan

et al. 2016

Journal of Children's Orthopaedics

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BackgroundThe demand for paediatric orthopaedic care is growing, and providing the service required is an increasingly challenging task. Physiotherapist-led triage clinics are utilised in adult orthopaedics to enable the provision of care to patients who may not require a surgical consult. The Physiotherapy Orthopaedic Triage Clinic (POTC) was established in Our Lady’s Children’s Hospital Crumlin in response to increasing demands on the paediatric orthopaedic service. The clinic is run by physiotherapists working in an advanced practice role (APP), and is the first paediatric clinic of its type and scale in the Republic of Ireland.PurposeTo evaluate the efficacy of the service over the 3-year period from January 2011 to December 2013.MethodsA review of the prospectively gathered database was performed in order to establish the demographic profile of patients, investigate clinic outcomes, and evaluate the reduction in patient waiting times.Results2650 patients were managed by the clinic over the 3-year period. A total of 77 % of patients were managed without consultant intervention. Fifty-three percent of patients were diagnosed as having a normal presentation. The mean waiting time reduced from 101.9 weeks pre-2010 to 15.4 weeks in 2013 for those patients managed by the POTC.ConclusionSince its inception, the clinic has significantly reduced waiting times for routine elective paediatric orthopaedic patients while managing the majority of patients independent of surgical opinion. This study shows that the APP can deliver high-quality care in the paediatric orthopaedic setting, benefitting both patients and service.

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“…The bipedal gait of an infant is not a smaller version of the adult gait but has its own unique developing biomechanical patterns (Rose & Gamble, 1994 ). Early walking is typically described as having a wide stance combined with flexion of both the knee and hip (Cowgill et al, 2010 ; Hallemans et al, 2005 ; Johnston et al, 2014 ; Sutherland, 1997 ; Sutherland et al, 1988 ). During this stage, the plantar fat pad defends the foot against overloading, dispersing the plantar pressure throughout the foot (Bosch et al, 2007 ).…”

Section: Discussionmentioning

confidence: 99%

The developing juvenile distal tibia: Radiographic identification of distinct ontogenetic phases and structural trajectories

2022

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A novel combination of radiographic colour gradient mapping and radiographic absorptiometry was utilised to examine 96 human distal tibiae from 54 individuals ranging in age‐at‐death from the foetal to 23 years. The purpose of this was to identify previously undocumented changes in the internal organisation during the development of the distal tibia and determine whether these changes could be described as distinct phases. Previous studies have demonstrated a rudimentary structural organisation in other skeletal elements that mirror more mature patterns of bone organisation. Results showed that the perinatal tibia did not exhibit a rudimentary structural pattern similar to the architecture observed within the late adolescent tibia. This lack of early internal organisation is hypothesised to be related to the rudimentary ossification process that is being laid down around a pre‐existing vascular template which will be subsequently modified by locomotive forces. Between birth and 2 years of age, the tibia exhibited a period of regression where radiodensity decreased in comparison to the perinatal tibia. This period of regression was postulated to be due to a combination of factors including changing locomotive forces, weaning and growth resulting in a stage of development which is extremely demanding on calcium liberation from the skeleton. After 2 years of age, the distal tibia demonstrated refinement where radiographic trajectories progressively developed into patterns consistent with adult trabecular organisation. These trajectories are linked to the forces associated with the bipedal gait, suggesting a strong influence of biomechanical forces on the development of the distal tibia.

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Variations in normal gait development

Cited by 13 publications

References 2 publications

An evaluation of diagnostic agreement rates between advanced practice physiotherapists and paediatric orthopaedic consultants for children with musculoskeletal complaints

An evaluation of diagnostic agreement rates between advanced practice physiotherapists and paediatric orthopaedic consultants for children with musculoskeletal complaints

The efficacy of an extended scope physiotherapy clinic in paediatric orthopaedics

The developing juvenile distal tibia: Radiographic identification of distinct ontogenetic phases and structural trajectories

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