title: Pathological gait in children with Legg-Calvé-Perthes disease and proposal for gait modification to decrease the hip joint loading.
abstract: OBJECTIVE
  Legg-Calvé-Perthes disease (LCP) severely limits the range of hip motion and hinders a normal gait. Loading of the hip joint is a major consideration in LCP treatment. The aim of this study was to evaluate gait patterns in LCP and identify gait modifications to decrease the load on the affected hip.
  
  
  METHODS
  Forty children with unilateral LCP were divided into three groups based on the time base integral of the hip abductor moments during single stance on the affected side acquired during instrumented 3D gait analysis. X-rays of the affected hip were classified according to Herring and Catterall.
  
  
  RESULTS
  Children in the "unloading" group spontaneously adopted a Duchenne-like gait with pelvis elevation, hip abduction and external rotation during single support phase. The "normal-loading" group showed pelvis elevation with a neutral hip position in the frontal plane. In the "overloading" group the pelvis dropped to the swinging limb at the beginning of stance accompanied by prolonged hip adduction. The time base integral of the hip abductor moments during single stance correlated positively with the X-ray classifications of Herring and Catterall, hip abduction angle and age. Older children preferred to walk in hip adduction during single stance, had more impaired hips and tended to overload them.
  
  
  CONCLUSIONS
  The hip overloading pattern should be avoided in children with LCP. Gait training to unload the hip might become an integral component of conservative treatment in children with LCP.
authors: Pediatric Orthopaedic, Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, Graz, 8036, Austria.
authors: Martin
authors: M
authors: Svehlík
authors: Tanja
authors: T
authors: Kraus
authors: Gerhard
authors: G
authors: Steinwender
authors: Ernst B
authors: EB
authors: Zwick
authors: Wolfgang E
authors: WE
authors: Linhart
mesh_terms: D002648:Child; D005081:Exercise Therapy; D005260:Female; D005684:Gait / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D006621:Hip Joint / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000503:physiopathology; D007873:Legg-Calve-Perthes Disease / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D016059:Range of Motion, Articular; D020127:Recovery of Function; D016474:Weight-Bearing