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Updated: Oct 12, 2025
Clinical-oriented Three-dimensional Gait Analysis Method for Evaluating Gait Disorder
Published on: March 4, 2018
Relationship between 3D lower limb bone morphology and 3D gait variables in children with uni and bilateral Cerebral
Rodolphe Bailly1, Mathieu Lempereur2, Matthias Thepaut3
1Fondation Ildys, Brest, France; LATIM, Inserm U1101, Brest, France; Université de Bretagne Occidentale, Brest, France.
Insights
Bone shape in children with cerebral palsy (CP) weakly impacts walking patterns. Gait analysis is crucial for treatment decisions, as other factors significantly influence gait quality beyond tibial-femoral morphology.
Area of Science:
- Orthopedics
- Pediatrics
- Biomechanical Engineering
Background:
- Children with cerebral palsy (CP) often have bone deformities affecting gait.
- Current interventions assume a strong link between bone deformities and gait deviations.
Purpose of the Study:
- To investigate the relationship between tibial-femoral bone morphology and kinematic gait variables in ambulant children with CP.
- To determine if bone morphology explains gait deviations in children with CP.
Main Methods:
- Retrospective analysis of 121 children with unilateral or bilateral CP.
- Utilized 3D gait analysis and biplanar X-rays (EOS® system).
- Performed multivariable linear regressions between kinematic variables, Gait Deviation Index (GDI), and 3D bone morphology.
Main Results:
- Tibial-femoral bone morphology models explained less than 1% of GDI variability overall.
- Correlations between bone morphology and hip rotation were mostly poor.
- Mean foot progression angle showed moderate correlation with bone variables (25-48% variability explained).
Conclusions:
- Tibial-femoral bone morphology has a weak relationship with kinematic gait variables in children with CP.
- Factors other than bone morphology significantly influence gait quality.
- Clinical examination and gait analysis are essential for guiding treatment decisions.
Background:
Medical and surgical interventions to prevent or reduce bone deformities and improve gait in children with cerebral palsy (CP) are based on empirical evidence that there is a relationship between bone deformities and gait deviations.
Research Question:
What is the relationship between tibial-femoral bone morphology and kinematic gait variables in ambulant children with CP?
Methods:
A retrospective analysis was conducted on data from 121 children with uni- (n = 64, mean age 9.9 (SD 3.4) years) and bi- lateral (n = 57, mean age 10.4 (SD 3.6) years) CP who had undergone 3D gait analysis and biplanar X-rays (EOS® system). The limbs were split as DIP (the more impaired limb of children with bilateral CP), HEMI (the impaired limb of unilateral CP) and REF (the unimpaired limb of unilateral CP). Multi-variable Linear Regressions were performed between 23 kinematic variables, the Gait Deviation Index (GDI) and a model composed of nine 3D bone variables for each limb type.
Results:
When the whole sample was pooled, 72% of R2 values were poor, 16% were fair, and 12% were moderate. Lower limb bone morphology models explained less than 1% of GDI variability. Correlations between tibial-femoral rotational parameters and hip rotation were mostly poor. Mean foot progression angle was the only kinematic parameter that was fairly to moderately correlated with bone variables in the 3 limb types. A tibial-femoral bone model explained 48% of the variability of mean foot progression angle in the REF limbs, 31% in the HEMI limbs and 25% in the DIP limbs.
Significance:
Tibial-femoral bone morphology was only weakly related to kinematic gait variables, in contrast with common clinical assumptions. These results suggest that factors other than bone morphology influence gait quality and thus a thorough clinical examination and gait analysis is required prior to making treatment decisions.
