An Evaluation of Orthotics on In-Toeing or Out-Toeing Gait

Area of Science:

• Pediatric Orthopedics
• Biomechanical Engineering
• Rehabilitation Science

Background:

• In-toeing and out-toeing gait are common rotational deformities in children with neuromuscular conditions.
• These abnormalities stem from internal tibial torsion, increased femoral anteversion, and metatarsus adductus.
• Lower extremity orthotics are frequently used non-operative treatments for these conditions.

Purpose of the Study:

• To comprehensively evaluate the effectiveness of lower extremity orthotics for treating rotational gait deformities.
• To assess the efficacy of various orthotic devices in correcting transverse plane deformities.
• To determine the impact of orthotics on ambulation stability and 3D joint motion.

Main Methods:

• A literature review of studies published after January 1, 1990.
• Searches conducted across multiple databases: CENTRAL, CINAHL, Medline, Scopus, and Web of Science.
• Inclusion of 13 studies evaluating 365 participants with neuromuscular conditions.

Main Results:

• Included studies comprised 2 RCTs (Level 1), 9 quasi-experimental (Level 2), and 2 case studies (Level 4).
• 69% of studies had a low risk of bias; 31% had a moderate risk.
• Compression garments and rotational systems demonstrated significant improvements in proximal lower extremity rotation (19.73° ± 1.57° and 24.13° ± 8.49°, respectively). Rotational systems showed the most significant change in foot progression angle (19° ± 26.87°).

Conclusions:

• Orthotic devices offer short-term benefits for children with neuromuscular disorders experiencing in-toeing or out-toeing gait.
• Compression garments may improve joint alignment and proprioception.
• Rotational systems provide precise alignment correction, while AFOs offer stabilization. Foot orthotics may suit mild cases.