National Physical Therapy Examination (NPTE) Practice Exam

A child with Legg-Calvé-Perthes disease is most likely to exhibit which gait deviation?

1. Vaulting

2. In-toeing

3. Toe-walking

4. Trendelenburg

The correct answer is: Trendelenburg

In Legg-Calvé-Perthes disease, there is an interruption of blood supply to the femoral head, leading to avascular necrosis. This condition typically affects children between the ages of 4 and 8 and can cause significant hip pain and limitation in hip movement. As the disease progresses, changes in the structure of the hip joint can occur, which in turn influences the child's gait. The Trendelenburg gait deviation is characterized by the dropping of the pelvis on the side opposite to the stance leg during walking. This happens due to weakness of the hip abductors, primarily the gluteus medius muscle on the affected side. Since children with Legg-Calvé-Perthes disease often develop a weakness in the hip abductors due to the underlying hip pathology, they may adopt a compensatory gait pattern to maintain balance, resulting in the Trendelenburg gait. Understanding this compensation mechanism is crucial for physical therapy treatment strategies aimed at strengthening hip abductors and improving gait mechanics. In contrast, other gait deviations such as vaulting, in-toeing, or toe-walking may be seen in different types of musculoskeletal or neurological conditions and are not the typical compensatory patterns associated with the specific challenges posed by Legg-Calvé