- Reduced time spent weight-bearing on the affected side.
- Spectrum of possible causes (e.g., trauma to sole of foot, spinal osteomyelitis). Unwitnessed trauma is common in young children. The child presents with unwillingness to weight-bear, so an index of suspicion is required.
- May be observed in juvenile idiopathic arthritis (JIA), although children may not always complain of pain. 
Circumduction gait (“peg leg”)
- Excessive hip abduction as the leg swings forwards.
- Typically seen with a leg length discrepancy, with a stiff/restricted joint movement as in JIA, or with uni-lateral spasticity as in hemiplegic cerebral palsy.
- Stiff, foot-dragging with foot inversion. This is often seen in upper motor neuron neurological disease (e.g., diplegic or quadriplegic cerebral palsy, stroke).
- Instability with an alternating narrow to wide base of gait.
- Seen in ataxic cerebral palsy affecting the cerebellum, cerebellar ataxia and Friedreich’s ataxia.
- Results from hip abductor muscle weakness. While weight-bearing on the ipsilateral side, the pelvis drops on the contra-lateral side, rather than rising as is normal. With bi-lateral hip disease, this results in a waddling “rolling sailor” gait with hips, knees and feet externally rotated.
- May be observed in Legg-Calvé-Perthes’ disease, slipped capital femoral epiphysis, developmental dysplasia of the hip, JIA involving the hip, muscle disease (juvenile dermatomyositis or inherited myopathies) and neurological conditions (spina bifida, cerebral palsy and spinal cord injury).
Toe-walking gait (“equinus”) with absent heel contact
- Habitual toe walking is common in children and associates with normal tone, range of movement around the feet and normal walking on request. However, persistent toe walking is observed in spastic upper motor neuron neurological disease (e.g., diplegic cerebral palsy) and may be a presentation of mild lysosomal storage disorder.
- The entire leg is lifted at the hip to assist with ground clearance. Occurs with weak ankle dorsiflexors, compensated by increased knee flexion (i.e., a foot drop gait).
- Observed in lower motor neuron neurological disease (e.g., spina bifida, polio) and peripheral neuropathies (e.g., Charcot-Marie-Tooth disease).
- This term is commonly used to describe difficulties in motor coordination (fine and gross motor skills). The child may present with frequent falls, difficulty in self-help skills such as dressing or feeding at school. Poor handwriting and learning disabilities may be noted.
- It is important to exclude specific albeit mild neurological disabilities (cerebral palsy, cerebellar ataxia or lower motor neuron disorders), indolent inflammatory arthritis or myopathies, and orthopaedic problems such as in-toeing. Metabolic disorders that may present with “clumsy walking” should also be considered.
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