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Impartial investigations identify wayward walking

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Children with arthritis may be stopped from adopting harmful walking patterns by objective analysis leading ultimately to individually targeted treatment, preliminary results have shown. The children studied had juvenile idiopathic arthritis (JIA) and variously affected lower limb joints. Clinical assessment of their gait identified three groups. Group A had minimal joint restriction (seven children); Group B moderate/severe restriction (and supinatory foot deformity) (six); and group C moderate/severe restriction (and pronatory foot deformity) (two). Objective measurement identified four patterns. Pattern I was near normal gait; pattern II was associated with lower leg pain; pattern III with lower leg deformity; and pattern IV lower leg pain and deformity.

Comparing these groupings showed that clinical assessment missed abnormal gait, as six children in group A had pattern I or II gait but only two of them pattern I. Group C children fell into pattern III. All six children in group B and one child in group A had pattern IV gait.

The prospective study included 15 children with JIA and symmetrically affected joints. Walking was judged clinically by experienced observers and objectively with two methods. The Visual Vector System showed the ground reaction force vector on a split video image in two planes during barefoot walking along a walkway. The Novel PEDAR insole system measured plantar pressure of consecutive steps along the walkway in non-adapted shoes.

Assessing gait correctly in JIA is difficult but important, as the children's gait is maturing. A previous attempt at objective analysis showed appreciable deviation from normal but limited analysis.

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