my child walks better without his smos/afos…

by Anne

I here this quite often from concerned parents. They are usually right in some respect. The child may walk faster without his SMOs or AFOs. So what are we looking for when watching your child walk in his/her new leg braces? Usually I am looking for three things: Stability, Consistency and the Development of a Heel-Toe Pattern of Walking. What does this look like in a young child (age 2-5) who is fairly new to walking?

When a child first learns to walk, they walk with their feet farther apart, their knees and hips bent, their arms held up and out for balance and they place their entire foot down in one movement. They also take very short steps and fall frequently. Within the first six months of walking, we usually see their arms lower and begin to swing by their sides. We also see greater stability, less frequent falls and different measurements in certain parts of their walking. These different measurements include the base of support (width their feet are apart while walking), step length (the distance between one foot hitting the ground and the next foot hitting the ground), cadence (the number of steps per minute) and velocity (walking speed). We also begin to see greater consistency and each step begins to look more similar. Within six to twelve months of learning to walk, we should see the gait pattern change so the child is using more distinct parts of his foot (hind foot, midfoot, and forefoot) while walking. This is the development of the most efficient way of walking, which we call a heel-toe pattern. When the child’s foot first hits the ground, he touches first with his heel. Then his body weight moves over his ankle until his whole foot is flat on the ground. This nice flat foot is really important to allow him to take a longer step with the opposite leg. As the opposite foot swings through to hit the ground, the foot that is on the ground rolls forward and the child pushes off the ground with his forefoot. This pushes the child forward into the next step and helps create momentum so he has to use less energy in walking a longer distance.

A heel-toe pattern is important in helping the child develop strength in his legs (in the shin muscles, the calf muscles and in the muscles that straighten and bend the knees). It is also really important to prevent tightness in the tendons & ligaments at the ankle, knees and hips. Without a nice heel-toe pattern, children often have to use compensations to walk and may fatigue more quickly.