Podiatry Department, University of South Australia, Adelaide, South Australia, Australia.
J Multidiscip Healthc. 2012;5:27-35. doi: 10.2147/JMDH.S28669. Epub 2012 Jan 25.
An intoed gait pattern is one of the most common referrals for children to an orthopedic consultation. Parental concern as to the aesthetics of the child's gait pattern and/or its symptomatic nature will primarily drive these referrals during a child's early developmental years. Whilst some of these referrals prove to be the result of a normal growth variant, some children will present with a symptomatic intoed gait pattern. Various treatments, both conservative and surgical, have been proposed including: braces, wedges, stretches and exercises, shoe modifications, and surgical procedures. However, which treatments are effective and justified in the management of this condition is not clear within the literature. The aim of this systematic review was to therefore identify and critique the best available evidence for the non-surgical management of an intoed gait pattern in a pediatric population.
A systematic review was conducted of which only experimental studies investigating a management option for an intoeing gait pattern were included. Studies needed to be written in English, pertaining to a human pediatric population, and published within a peer reviewed journal. Electronic databases were searched: Ovid (Medline), EMBASE, AMED, PubMed, SportDiscus, CINAHL, and Cochrane Library. The National Health and Medical Research Council's designation of levels of hierarchy and the Critical Appraisal Skills Programme cohort studies critical appraisal tool were used.
Five level IV studies were found. The studies were of varied quality and with mixed results. Gait plates, physiologic/standardized shoes, and orthotic devices (with gate plate extension) were shown to produce a statistically significant improvement to an intoed gait pattern. Shoe wedges, torqheels, and a leather counter splint were not able to reduce an intoed gait pattern.
There is limited evidence to inform the non-surgical management of a pediatric intoed gait pattern. The body of evidence that does exist is small (n = 5) and of varied quality, which means recommendations arising from this evidence base should be interpreted with caution. There is generally weak evidence that suggests that gait plates and orthotic devices with a gait plate extension may assist in the management of a pediatric intoed gait pattern.
内八字步态是儿童骨科就诊最常见的原因之一。在儿童早期发育阶段，父母对外貌和/或症状的关注是促使他们带孩子就诊的主要原因。虽然这些就诊中有一部分是正常生长变异的结果，但有些孩子会出现内八字步态的症状。各种治疗方法，包括支具、楔形物、伸展和锻炼、鞋类修改和手术，都已被提出。然而，在文献中，哪些治疗方法对这种情况的管理是有效和合理的尚不清楚。因此，本系统评价的目的是确定并评价针对儿科人群内八字步态非手术管理的最佳可用证据。
对仅研究管理内八字步态方法的实验性研究进行了系统评价。研究需要用英文书写，涉及人类儿科人群，并在同行评审期刊上发表。检索了电子数据库：Ovid（Medline）、EMBASE、AMED、PubMed、SportDiscus、CINAHL 和 Cochrane Library。采用澳大利亚国家卫生和医学研究委员会的等级划分和批判性评估技能计划队列研究批判性评估工具。
发现了 5 项 IV 级研究。这些研究质量参差不齐，结果也不一致。步态板、生理/标准鞋和矫形器（带门形板延伸）被证明对内八字步态有统计学意义的改善。鞋楔形物、扭矩鞋和皮革反夹板不能减少内八字步态。
目前几乎没有证据可以为儿童内八字步态的非手术治疗提供信息。现有的证据数量很少（n = 5），质量也参差不齐，这意味着从这一证据基础得出的建议应谨慎解读。一般来说，有较弱的证据表明，步态板和带门形板延伸的矫形器可能有助于管理儿童内八字步态。
