2. PARAS AYAZ
QURAT-UL-AIN MALIK
JAHANZAIB IQBAL

3. Festinating gait is a type of gait (walking)
characterized by a
Flexed trunk
Legs flexed stiffly at the knees and hip
Take short and slow steps while walking
The center of gravity is usually altered because
the person cannot stay balanced.
Patients with festinating gait also have difficulty
stopping their gait after starting.
This is due to muscle hypertonicity.

6. Parkinsonian gait (or festinating gait,
from Latin word [to hurry]) is the type
of gait exhibited by patients suffering from
Parkinson’s disease (PD). This disorder is
caused by a deficiency of dopamine in
the basal ganglia circuit leading to motor
deficits. Gait is one of the most affected
motor characteristics of this disorder
although symptoms of Parkinson's
disease are varied.

7.  Bradykinesia
 Tremors
 Rigidity
 Poor balance
 Abnormal walking

8.  PARKINSON’S DISEASE

9.  TIBIALIS ANTERIOR/ SHORTENING
 CALF M/S, GASTROCNEMIUS, SOLEUS
/SHORTENING
 QUADRICEPS AND HAMSTRING ON THE
OTHER HAND SHOW PROLONGED
ACTIVATION IN THE STANCE PHASE OF
GAIT.
 THIS IMPLIES THAT PATIENTS WITH
PARKINSON DISEASE HAVE HIGHER
PASSIVE STIFFNESS ON ANKLE JOINT.

10. WITH THE HELP OF DRUG
Parkinson’s disease, this would typically
involve treatment with L-dopa, which is a
precursor of the chemical messenger
dopamine, which is deficient in the disease.
The brain turns L-dopa into dopamine, thus
increasing dopamine levels in the brain. A
more drastic medical treatment is deep brain
stimulation, in which a device is implanted in
the brain to send electrical stimulation to
certain parts of the brain, such as areas that
control movement. A less drastic medical
treatment for festinating gait is exercise and
physical gait.

11. Other forms of treatment are
behavioral, such as providing the person with
external visual cues (e.g., floor markers)
and auditory cues (e.g., sounds) to help
regulate movements since the internal
regulatory cueing functions of the basal
ganglia (which regulate movements) have been
compromised. Visual cues have been shown to
be much more effective than auditory cues

12.  Physical therapy and exercise have been shown
to have positive effect on gait.
 Physiotherapist may help improve gait by
creating training program
 To lengthen a patients stride length
 Broaden the base of support by using tiles,
footprints on the ground to improve the foot
placement.

13.  To improve the heel-toe gait pattern
 Straighten out a patient posture
 Increase arm swing patterns
 Walking on treadmill has shown to improve
both walking, speed and stride length.

14.  AEROBIC EXERCISE
 MUSCULAR STRENTHENING (CON, ECEN)
 FLEXORS EXERCISE
 USE OF CORRECT WALKING AIDS SUCH AS
WALKING STICK OR WALKING FRAMES.

15. Alternate Names
In-toeing
false clubfoot
in-toe gait
metatarsus adducts
metatarsus varus

16. A pigeon gait, also known as in-toeing,
is a condition in which the front of the
feet turn inward, leading to a walk
which somewhat resembles that of
a pigeon. In most cases, pigeon gait
affects young children and is caused by
abnormal orientation of the thigh, lower
leg, or foot

17.  The immediate cause of a pigeon gait is an
inward turning of the feet.
 When an individual with inward-turning feet
walks, his gait often has a shuffling or
waddling quality that, in the eyes of some,
resembles the gait of a pigeon this condition
is known as in-toeing.

18.  Feet point inward, as if the toes are touching
 Stumbling (severe cases)
 Clumsiness

19.  There are 3 main causes of in toe gait:
Metatarsus adducts
Tibial torsion
Femoral anteversion

20. 1.The foot:
Pigeon toes occur when the foot
tends to resemble a kidney, or
when the metatarsus adducts has
an inward curve at the outer edge
of the foot.
Metatarsus adducts requires
treatment, the nature of which
varies depending upon whether
the condition is flexible or fixed.

21.  If conservative measures fail,
surgical correction will be
necessary, especially in cases of
club-foot. The sooner the patient is
diagnosed and treated, the better
the outlook for the patient
 Most flexible cases respond to
conservative treatment, which includes
passive stretching, bracing, and
specialized shoes. The fixed type
requires serial plaster casting.

22. 2. The knee:
 When there is an inward twist of the tibia
bone, the shin is twisted. This is commonly
seen in children learning to walk. Usually
the leg straightens out within the first year
of life, but some children may continue to
walk pigeon-toed until the leg bone is done
growing. Surgery may be necessary for
children who do not outgrow this condition
by the age of ten.

23. 3. The hip:
 In some cases the femoral anteversion
has an inward twist at the upper
thighbone. The knee caps tend to point
inward when the person is walking.
Most children show this form of in-
toeing between the ages of 2 and 4, after
they have begun walking. Typically, a
child will outgrow this condition by the
age of 8.

24.  Although this condition sometimes goes away on its
own, in some cases, it does not. This causes
complications for both the parents and the child.
 Shoes are typically the biggest complication. The
parents of most pigeon-toed children are unable to find
shoes that fit them properly because of the curve of
their feet. This can be frustrating, and finding the right
shoes can become costly for the parents.
 Children who are pigeon-toed may feel
embarrassment if they walk differently than other
children their age.

25.  Most diagnoses of metatarsus adducts or true club-foot in
infants occur well before they even begin to walk, and
these children need immediate treatment.
 An infant who does not have metarsus adducts or true
club-foot will still appear to in-toe when they begin to
walk.
 This is normal up to about the age of three, and it is
because of the structural difference in the infant’s foot and
the changes that have yet to occur in the leg (the tibia) or
the femur (ante version).
 On the other hand, if the in-toeing continues after about
age 3, this is concerning. Therefore, children should be
examined regularly by a podiatrist to ensure that the
bones are developing correctly and the child’s gait is
progressing correctly.

26.  Most of these conditions are self-correcting
during childhood. In the worst cases surgery
may be needed.
 Most of the time this involves lengthening the
achilles tendon. Less severe treatment options
for pigeon toe include keeping a child from
crossing his or her legs, use of corrective shoes
and casting of the foot and lower legs, which is
normally done before the child reaches 12
months of age or older.
 If the pigeon toe is mild and close to the center,
treatment may not be necessary. Ballet has been
used as a treatment for mild cases.

27.  Pigeon-toed feet is a common orthopedic condition in
young children.
Some examples of exercises to correct pigeon toes;
 Step 1
 Have your toddler or young child sit up straight in a
child-size firm chair.
 Children with pigeon toes tend to naturally sit with their
legs crossed.
 Help your child sit in the chair with her legs uncrossed
and feet flat on the floor.
 Trace her feet in the correct slightly-outward position
onto a piece of paper.

28.  Step 2
 Show your young child how to walk backward.
 Have him follow you in the backward walking.
 Continue the exercise for up to 10 to 20 minutes
or as long as he is able to do so.
 This exercise helps to strengthen the hip joints
to keep the feet straight while walking. Repeat
this exercise regularly during play and walking
time.

29.  Step 3
 Place the board of wood on two square pieces of wood or
2 bricks.
 Keep the plank only three to five inches above the
ground to avoid injury due to falling.
 Help your child walk across the full length of the plank
two to four times a day and continue this exercise
regularly until she is walking normally.
 This exercise helps the child place one foot in front of the
other correctly, and strengthens the muscles that keep
the hip and shin bones aligned.