Pilot study: Effect of Developmental Dysplasia of the Hip on the Gait and Feet Posture

Abstract

Background: The objective of this pilot study was to assess the effect of Developmental Dysplasia of the Hip (DDH) on gait, in pediatric participants, between the age of one to four years. Few studies are investigating the effect of DDH on the walking pattern within the pediatric rehabilitation practice. From an early age, children are developing a longitudinal foot arch. Constantly changing pediatric foot posture must be assessed. Gait pattern and foot posture are one of the most common parental concerns.
 Methods: The retrospective review of gait analysis, performed on 410 lower limbs, took place in King Abdullah Specialized Children Hospital (KASCH) in Riyadh, Kingdom of Saudi Arabia, from April 2020 until September 2020. All participants were diagnosed with DDH by pediatric orthopedics physicians in KASCH. Gait analysis was done by a physical therapist twice within three months, using The Wee Glasgow Gait Index (WeeGGI) and foot assessment was done once using Foot Postural Index (FPI-6). The WeeGGI compares eleven gait parameters. Each parameter has a choice of three figures, where each one has a clear explanation and/or value. The FPI-6 evaluates the foot as multi-segmental complex, in double leg support, characterizing pronation with + (plus) and supination with - (minus) numbers. Scoring is 2 (two) points in all six factors it is divided into rearfoot and forefoot assessment in transverse, frontal/transverse, frontal, and sagittal planes.
 Results: From all gait analyses (n=410). We included only 292 (71%) lower limbs with DDH and had to exclude 60 (15%) after hip surgery, 30 (7%) with another diagnosis, 18 (4%) without conservative treatment of DDH, and 10 (3%) with age above 48 months. According to the scoring of the Wee Glasgow Gait Index within the optimum/normal limits (score 0 - zero), we had 50 (17%), mild deviation (score 1-11) 236 (81%), and gross deviation (score 12-22) had 6 (2%) limbs within first gait analysis. With second gait analysis, 40% of lower limbs were within optimum/normal limits, 60% with mild deviation in gait, and zero within gross deviation. Every limb assessment for gait had the Foot Postural Index as well. Within normal limits (0 till +5) we had 143 (49%) feet, pronation (+6 till +9) was presented in 97 (33%) and high pronation (more then +10) had 52 (18%) pediatric feet. This sample did not present supination (-1 till -4) or high supination (-5 till -12). Limping was observed within 102 (35%) of the legs. The frequency of W-sitting presented in 47% of the results. The first and second gait analysis suggest an effect of DDH on the gait with a small difference between the right and left leg, although the left side was affected more within both gait analyses.
 Conclusion: Pathological gait pattern with DDH was detected in 83% within the first gait analysis, 60% within the second gait analysis, and Foot Postural Index revealed pronation of 51% feet. Among Saudi participants, a relatively high effect of DDH on gait patterns is reported in this pilot study.
 Keywords: DDH, gait, FPI-6, physiotherapy, WeeGGI.