Identifying the most prominent transversal gait patterns in children with torsional deformities using cluster...

Several studies examined specific torsional deformities and correlations between imaging and 3D gait analysis. However, an overview of common gait patterns in combination with computer tomography-verified torsional profiles is currently lacking. The aim of the current study was to identify the most prominent gait patterns in children with torsional deformities. Pediatric patients (n = 165), who were referred to gait analysis and computer tomography to evaluate torsional deformities, were included in this retrospective study (exclusion: any neurological diseases). Kinematics of the more affected leg were analyzed. Transversal joint angles during stance were used for clustering. After identifying the optimal number of clusters, kinematics across the gait cycle and anthropometrics were compared between clusters and typically developing children (n = 46; 11.8 ± 3.3 years) using one-way ANOVA (α = 0.05) with Bonferroni corrected post-hoc tests (α = 0.005). Four distinct clusters were identified: C1 (n = 44; 13.8 ± 1.6 years, BMI: 19.2 ± 2.4, f/m: 23/21) - functional malalignment group with excessive external tibial torsion; C2 (n = 26; 12.6 ± 1.4 years, BMI: 24.6 ± 6.0, f/m: 5/21) - reverse malalignment group characterized by high hip external rotation and low tibial torsion; C3 (n = 35; 12.9 ± 1.3 years, BMI: 18.6 ± 2.9, f/m: 22/13) - in-toeing group (tendencies to higher hip internal rotation); C4 (n = 60; 13.3 ± 1.8 years, BMI: 23.0 ± 5.0 years, f/m: 8/52) - decreased femoral torsion group. Comparison of gait kinematics and torsion values showed some C1 patients compensated with internal hip rotation, while some C2 patients compensated with external hip rotation. Transversal gait patterns were only partially explained by torsional profiles from imaging highlighting the need to consider individual gait kinematics when treating these patients.