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The aim of this section is to give
Podiatry students and practitioners
a basis for paediatric assessment.

To gain maximum benefit, prior

knowledge of the terms and
procedures discussed, is required, as
this is simply guide to give
practitioners a structured basis for
assessment and thought provocation.
This topic contains information to assist
practitioners and podiatry students in
more effectively assessing child patients.

This site gives an outline for assessing

children, Normal developmental
milestones for a 0- 2 year old, Gait
patterns in normal children of 1-6 year old,
Foot bony growth and ossification
information, a guide to increasing
consistency with measurement and a
summary of conditions that can affect the
lower limb of children
:ntroduction to patient:

Your introduction and first impressions is very

important in attaining good rapport with the patient
and with the patients guardian.

Remember to allow for and incorporate the child's

break time/play time. Be friendly because the child
will initially consider you a stranger. (Evans 1998)

Try to create a relaxed environment, with casual

dress (preferably not a white coat)
Introduce yourself- first name basis may be
appropriate
Interaction with the parent/guardian may save time to
gain the patient history
An easy starting question is: What can I help you with?
omplaint
Assess whether the presenting
complaint is accurate with the referral
Say: The person who referred your
child was concerned with «.. have you
noticed any problems? (to parent.)
:f so in what situations/circumstances
is the condition improved or worsened?
Family History:
Has anyone in your family had
any problems with their feet?

:s there a family history of any

medical history that may be
pertinent in this case?
ãedical History:
Does the child see his/her doctor
regularly for any reason.
Does the child take regular
medications, prescription or OT?

Previous Treatment:
Has the child had any previous
treatment for the problems?
:f so what and by who?
Neurological assessment:

Babinski test

Patellar and ankle reflexes

Other reflexes if appropriate:

Oral reflex, moro reflex, grasp reflex,

placing and walking reflex, tonic head
reflex
Biomechanical assessment:
Kait analysis ± observe child in shoes and without,
wearing underclothes if possible, take note of any
asymmetry of posture and gait cycle.

Weight bearing assessment- check vertebrae for

shape, deformity and movement, presence of
lordosis, scoliosis or kyphosis (functional or fixed),
check for trendelenburg sign

Non weight bearing assessment ±check for pain and

swelling, obvious deformities, signs of weakness,
symmetry in joint motion, direction of joint motion,
quality of motion, soft tissue lumps, enlargements of
bony area.
Assessment should look at:
ips- dislocations, gluteal folds, coxa varum/valgum
Knees- genu varum/valgum, genu recurvatum,
patella rotation, tibial varum
Ankles- malleolar position (tibial torsion), rearfoot
alignment
Mid-tarsal- forefoot to rearfoot alignment
Lateral contour (look for uneven lateral contour in an
abducted forefoot diminishing by standing on tippy
toes)
Talar bulging- foot shape assessment
Sub talar joint- resting calcaneal stance position,
neutral calcaneal stance position
Check footwear for normal/abnormal wear and
appropriate size, and support
Next review:

:t is important to keep an eye on children who

receive no treatment, as this will please parents
and yearly reviews are important to assess future
development.
³:t must be stressed that the majority of paediatric
problems are usually normal development
variations, rarely requiring anything more than
explanation and reassurance.´
Normal Development

:t is important for a podiatrist to fully understand

and be able to recognize the developmental
milestones when undertaking a biomechanical
assessment of a paediatric patient.
Newborn babies

Knees
New born babies present with genu varum, being on an
average 16 degrees varus. Within three years will have
changed to 11 degrees of genu valgum. (Maximum at 3.5-4
years old) By 9 years of age will have changed to a mean
value of 6 degrees genu valgum.

Ankle
50 degrees dorsiflexion, 30 degrees plantarflexion

Foot
the forefoot is 10-15 degrees inverted on the rear foot
B-6 Week old
Hips
Š:1 external/internal ROM
Check for hip dislocation

Knees
Kenu varum
Equal internal/external genicular position

Foot
Midtarsal transverse ROM greater than that of
an adult foot

Spine
No kyphosis
6-7 month old child
"ãost babies will sit unassisted and attempt to
crawl, they will start to pull themselves up into a
standing position and stand holding onto furniture,
but will frequently fall backwards into a sitting
position.
Hips
At rest the hips are naturally flexed and
bducted. 90:45 degree ROM at hips (external:
internal) or Š:1 ratio

Knees
Coxa valga/Kenu varum is evident. A medial
genicular position.

Forefoot
The forefoot is inverted on the
rearfoot. Adduction of forefoot on rearfoot
(should be reducible)

Rearfoot
The rearfoot is varus compared to the leg.
Tibia
Tibial torsion is neglible (increases until 6-7 years of age)

Spine
Lumbar lordosis is developing (at birth the spine is in
flexion over entire length)

Ankle
The ankle is slightly plantarflexed. Note- Restricted ankle
dorsiflexion can be an indicator of cerebral palsy or
congenital talipes equino varus. Restricted plantarflexion
can be an indicator of congenital calcaneovalgus.

General
The trunk is longer than the legs, but at Š years the trunk
will equalize with the leg length.
12 months
"The child should be able to stand alone
for a few seconds and may possibly walk
alone ³
(Kilmartin et al 199?)

Kilmartin et al 199? says that 97% of

children walk between 9 and 16 months
Hips
ip flexion exaggerated in absence of pelvic
rotation External hip rotation still more than internal
ROM Wide base of gait Lateral limb rotation -Abducted
foot positionKneesMild knee flexion Kenu valgum

Knees
fully extendable now with minimal resistance Still
obvious medial genicular postion, but medial and
lateral ranges are closer

Foot
No adduction of forefoot in transverse
plane Plantargrade foot Normally pronated foot
Spine
Lumbar lordosis

Ankle
Ankle joint can reach at least Š0 degrees dorsiflexion
and full plantarflexion

General
Movement dominant in sagittal and frontal
planes Toe standing seen

Arms held high to assist balance

2 Years
Knee
Medial and lateral genicular ranges are now
approximately 1:1 ratio

Hip
ip external/internal rotation should be ratio 1:1
Determinants of Gait
Adapted from Kilmartin et al 1995

By the sixth year there is little to differentiate

the child¶s gait from that of an adult
 :nitial stages of gait

- stomping gait with the entire limb being lifted

- circumducted over the ground and then plunged down again.
- little frontal of sagittal plane movement at the pelvis.
- leg is in an externally rotated position.
- foot neither supinates or pronates
- little demand on the ankle to either dorsiflex or plantarflex.
- Kait is apropulsive, shock absorption minimal and velocity
control poor.
- Patellar should be externally rotated
By 2 years of age

- foot doesn¶t yet supinate in toe off

- pelvis beginning to rotate in all plane of motion
- leg showing signs of internal rotation at heel contact
- velocity control is much improved
- patellar should be externally rotated
By 4 years of age

- gait no longer apropulsive

- heel lift and sub talar joint pronation now apparent
- leg and pelvic rotations are fully developed
- it is not uncommon to see toe-walking
- transverse knee range of motion should be equal
- patella should face forwards
 Five to six years of age

- Pronation-supination phases of gait fully developed

- Stride length increased
- Child over six years should have a symmetrical arm
swing
- At about 6 years old malleolar position will reach adult
levels at about 13-18 degrees
 Growth and ossification
Bone growth of the foot

- In terms of treatment knowing approximate

ossification times is important to determine the
most appropriate time of intervention.
- Boys (19-Š0) and girls (15-17) years old, will have
come to the end of lower limb maturity.
- Epiphyseal centers appear between Š and 7 years
for phalanges
- Epiphyseal centers appear between 3 and 4 years
for metatarsals, and ossify around 14-16 years for
females and 16-18 for males
-
- The calcaneus and talus appear after 4 weeks
- The short bones of the midtarsus are formed
before birth
- The sesamoids of the first metatarsal appear around
8 ±10 years of age

ãost anatomical books will provide a useful table

of ossification events for further information.
ãeasurement Technique
onsistency in measurement is a major part of
proper biomechanical assessment.

This page is aimed at giving a brief guideline

into increasing your consistency in
measurement
- heck goniometer for accuracy and consistency of all
ends of the axis

- alibrate your angle finder against a plumb line

- Position yourself for optimum planar orientation to the

body segments

- Stabile all associated body segments

- Accurately locate bony landmarks

-Ìse consistent grip on the segment

-Note the potential for skin grip

-Follow the sequence of procedures when specified

-Lift the segment to R-1 end range

-Push slowly to R-2 and watch for discomfort

- onsistently select the same measurement tool

-îxecute the test first and place the measurement
tool last

-Place your measurement tool accurately on the

involved body segments

-Repeat each measurement 2-B times and average

your results

- Strive diligently for maximum precision

Developmental conditions

:dentifying problems as early as possible is

essential in preventing problems in later life,
this is why thorough assessment is crucial in
paediatric patients.
References
Bodysync Custom Orthotic Specialists omepage
[ONLINE] (June Šnd Š000) Available:
http://www.bodysync.net/conditions.htm
Cusick, B. (1995) O
 

 

 

 


  



 Telluride
Community Television Productions.
Evans. A. (1998) 



 
  

  University of South Australia
Kilmartin, T., Tollafield, D. and Nesbitt, P. (1995) 


  
 IN Merriman, L. and Tollafield, D.
Assessment of the lower limb. Churchill, Livingstone
London p. 319- 3Š8
TInley. P. (1995) O
 

Queensland
University of Technology.