Gait Plates

By Craig on June 29, 2013 in

Wikis > Foot Orthotics > Design Features > Gait Plates

Gait plates are a foot orthotic design feature that are commonly used to try and alter the angle of gait in children with an in-toe or out-toe gait pattern by altering the line of flexion or bend of the shoes across the metatarsophalangeal joints with an extension on the medial or lateral distal ends. Gait plates can be prescribed as an extension on custom made foot orthotics and is available on a few prefabricated foot orthotic models. They could also be fashioned from a flat piece of rigid material such as polypropylene or carbon fibre.

They appear to be first described by Richard O Schuster in 1967 as a flat, rigid plate that was cut to the outline of the shoe:

Schuster RO. A device to influence the angle of gait. J Am Podiatry Assoc. 57(6):269-270, 1967 (link)

How do the gait plates work:
Typically the flex or bend in shoes is at a right angle to the line of progression in gait. The purpose of the gait plate is to change the angle of that bend to change the angle of the flex in the shoes and thus change the gait angle. The gait plate does need to be used in a shoe that is flexible enough in the forefoot to allow it to change the angle of the flex.

To induce an in-toe, the distal edge of the foot orthotic shell is cut proximal to the fifth metatarsal head and extended distal from the first metatarsal head to the sulcus of the first toe. The length can be varied depending on the severity of the out-toe gait pattern and the force required to induce an internal rotation moment:

In-toe gait plate

To induce an out-toe gait, the distal edge of the foot orthotic shell is cut proximal to the first metatarsal head and extended distal from the fifth metatarsal head to the end of the fifth toe. The length can be varied depending on the severity of the in-toe gait pattern and the force required to induce an external rotation moment:

Out-toe gait plate

Research on Gait Plates:
Schuster (1967):

the first study on gait plates; reported a 15° improvement in angle of gait

Redmond (1998)

6° improvement in angle of gait, as well as reduced incidence of tripping in 14 out of 18 children

Redmond (2000)

gait plate inlays resulted in a small but statistically significant reduction in the amount of in-toeing as measured by foot placement angle. Gait plates reduced the reported frequency of tripping in 14 of the 18 cases. The reported parental satisfaction was high or very high in all but one case

Munuera et al, (2010):

48 children (6.88 ± 3.25 years) with in-toed gait; reduction of in-toeing between unshod and shod plus orthotic device was 5.30° and and between shod and shod with orthotic device was was 3.60°

Ganjehie et al (2017):

17 children with an in-toe gait pattern( 7.2 ± 1.7 years of age) due to femoral anteversion; measured angle of gait and center of pressure displacement with and without an in-toe gait plate; the gait plates improved the gait angle by a mean of 11.1° compared to barefoot and 7.31° compared to shoes only.

Commentary:

The effectiveness of gait plates is probably commonly overstated and a lot of the reported efficacy is probably a cosmetic change in the gait angle. It is not known if these devices have a long term effect on the gait angle and if the cosmetic changes seen when wearing the device persist after ceasing their use. Any long term change could just be due to the natural history of the torsional problem.
Gait plates are much more commonly used for an in-toe gait pattern.
They probably should only be used after a thorough assessment is done as to what segment in the lower limb that the in-toe or out-toe gait pattern is coming from and if there are more appropriate interventions (or no intervention) is better directed at that cause.
Gait plates are unlikely to be effective if the sole of the shoe is rigid.
They are occasionally advocated for torsional gait issues in adults, but the anecdotes of the clinical experience on this is that it may or may not help.

Prefabricated gait plates: littleSTEPS® Gait Plates (Nolaro24);