Gait Plates responses

Gait Plates responses

Ben McMurtrie

5/19/2001

Thankyou to all who responded to this message.
The overall response is that Gait plates do not significantly alter
in-toeing gait patterns. All the evidence in articles and in the
internet are all anecdotal without any significant evidence supporting
thier use either way.
My follow up to this is not to try these.In the name of curiosity and
investigation the 113 y.o lad is a mates son who I may make some for
(without cost) to see if we can observe any changes for a week or so.
Thankyou
Ben

MESSSAGES RECIEVED:

Hi Ben:
The ability for an orthosis to address in-toeing is, in the least,
highly questionable, and that's for the very young
child. That is, to actually change a gait pattern while the orthosis
is not being worn. As the children you reference
are well beyond their more formative years, orthopaedically speaking,
this is not worth pursuing with any type of orthosis
or foot plate. Only in extreme cases, where function is significantly
impaired, should the solution of derotation tibial
osteotomies be considered.
-Don Katz, CO
Director, Orthotics Department
Texas Scottish Rite Hospital for Children
Dallas, TX

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We are a custom orthtoics lab, and we get calls to make gait plates
every
month. They are effective in reducing the in-toe/out-toe angle. The
very
deep walled UCBL foot orthotic is also effective in returning the gait
to a
more regular position. As with most foot orthotics clinical studies do
not
really exist. The evidence is anecdotal, but typically the cost of a
Gait
plate/UCBL for a child is not expensive, and you should also be able to
buy
non-custom devices for an interim trial.


            Seamus Kennedy, Hersco Orthtoic Labs
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Ben,

My limited experience is that for the ages involved only surgery will
change
the rotation. Do not waste time and money on positioning devices, it is

extremely unlikely that they will effect the intended structures.

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This will be a very vague reply but I remember being involved with a
young
girl when I was in London, however I cannot remember exactly what we did
in
terms of wedges and floats where. I'm pretty sure she had an intoeing
gait
which was not considered enough of a problem in terms of femoral or
tibial
torsion to warrant surgery and we adapted her shoes in such a way with
wedges and floats to alter her foot position in stance. I have a
feeling it
worked quite well intially but am not sure of the long term outcome. If
you
want to ring me please feel free.

Kaisha

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Ben you can have them sleep with a Dennis Brown bar at night with open
toe
shoes.Most DR. do not treat toeing in as a problem and when asked say
that
the patient will straigten out with time. Rick Chavez CPO . good luck

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I have not found great results with thes plates. Please tell me other
peoples findings if you would please.

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Hello Ben,

I have used gait plates, but it was quite some time ago, as they are
pretty much
out of favor in the southwest USA region now.

Probably 15-20 years ago, rohadur gait plates were quite popular for my
younger
patients with in-toeing problems. We really didn't have much success
with
limiting motion of the 5th MP, and the prescription was generally more
for the
parents' peace of mind than for actual correction. Allowing the
children to
only sit cross-legged instead of between their legs had more beneficial
affect.
>From some old studies I recall reading, very young children often grow
out of
the in-toeing gait regardless of treatment or not. In my personal
observations,
unless the problem was due to habit or only a muscle imbalance, gait
plates
really had no effect. We often had to use them along with torsion
cables, and
you are probably aware of the havoc caused with the tendons of the knee
with
such combinations. I haven't seen that gait plates alone have done any
harm in
my 27 years of practice in orthotics, but I still view them as placebos,
FWIW.

Respectfully,
Phil Heberer, L.O.
Texas Licensed Orthotist

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An alternative to the gait plate is the lateral Dutchman wedge, or
lateral sole wedge. I was taught to make these by
splitting the welt of a hard-soled shoe and slipping a piece of skived
soling leather in between the welt and the sole. The
insert piece is gibbous moon shaped and extends about 3/4 of the width
of the sole at the metatarsal head level. The welt
is then restitched with the Landis stitcher.

These Dutchman wedges (lateral for intoeing or medial for out-toeing)
do make a noticeable difference in the child's gait.
However, there is no evidence that they lead to a significantly
different outcome in the long run. For this reason they
have been largely discarded. Parents often like the appearance, even
knowing that the wedges are providing only a cosmetic
benefit. I think that gait plates have the same limitations.

Sincerely,


Kevin Felton, CO, LO
Education Coordinator, Orthotics Department
Texas Scottish Rite Hospital for Children

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RESPONSES RECIEVED BEFORE 20-5-01


--
Ben McMurtrie- Principal Orthotist
Geelong Orthotics P/L
70 Bellerine St
Geelong, 3220
Victoria
Australia
Ph: +61 03 5224 2200
Fax: +61 03 5223 3229
Mob: 0412 822 427
E: <Email Address Redacted>