Q: How do I know if a toe-out gait plate is appropriate?
A: I have had a lot of concerns about the misappropriate use of Toe out plates for kids, so I am glad you are asking.
Yes, we have Toe Out Gait plates. They are used for kids with true toe out gait. With that in mind, if a child (or adult) is walking toe out, they likely have external tibial or femoral torsion and a supinated foot. See below…
This is from an article by Volpe:
“A gait plate to induce in-toe is rarely used. The biomechanical concept is the same with the distal angulation in the reverse direction. It is most appropriate for a child with an external femoral or tibial torsion without pronation of the foot. However, using an orthosis to control motion of the foot in a child with compensatory pronation will sufficiently reduce abduction and out-toe in most case.”
http://www.podiatrytoday.com/article/894?page=3
So my concern is that practitioners not confuse an abducted forefoot (associated with foot pronation), with a truly toe out gait from external torsion. See the images above: The first picture shows a pronated foot, with flat arches causing an abducted forefoot (ie NOT TRULY TOE OUT). The toe out picture on the right show a true toe out (in this picture would look like external tibial torsion). If the tibia or femor has external torsion, that would supinate the foot and raise the arch.
I hope that helps you understand when it is appropriate to use a toe-out git plate.