The development of mature gait

We must understand the natural history of immature walking in order to define and interpret pathological gait in young children. Step length, cadence and walking velocity show evidence of both central nervous system maturation and growth until approximately 4 years of age. Until 4 years-of-age the step factor (step length divided by leg length) increases, but thereafter the step factor remains constant and adult-like. After 4 years-of-age the changes in velocity, cadence, step length in normal children are appropriately attributed to changes in limb length. Dynamic joint angle measurements indicate stabilization of gait by 3 to 4 years-of-age. However, there is greater inter-subject and intra-subject variability of gait in children of all ages than of adults. Force plate measurements of subjects 2 to 7 years-of-age show an increasing definition of the mid-stance trough in the vertical force curve. The second peak of the vertical force curve is deficient, by adult standards, particularly in the younger age groups. Moment and power curves of hip, knee and ankle in subjects 4 years and older show patterns not unlike those of adult subjects. There are differences in magnitude, suggesting that the youngest children use their hip flexor and extensor muscles more than their ankle plantar flexors for power generation. A study from another center shows no age-related differences in hip, knee and ankle powers in children 5–16 years of age. All of the studies reported are very helpful in understanding gait maturation but researchers are needed to address remaining questions.