Gait analysis in children with bladder exstrophy shows increased hip adduction, knee valgus and external foot progression in comparison with control participants

BACKGROUND: Bladder exstrophy is a congenital malformation occurring in fetal development characterized by an open pelvic ring and inferiorly rotated pelvis, impacting typical gait and development. Little is known about the gait patterns in children with bladder exstrophy, especially if they undergo an osteotomy surgery for pelvic reconstruction. OBJECTIVE: This study aimed to investigate gait patterns of children with and without bladder exstrophy, as well as children with bladder exstrophy with and without osteotomies. METHODS: Fifteen participants with bladder exstrophy (mean age 10.6 y; range 5-15 y) and 19 controls (mean age 11.7 y; range 7-15 y) performed a three-dimensional gait analysis. Statistical parametric mapping compared kinematics, kinetic and power data between groups at the level of the pelvis, hip, knee and ankle. Hotteling's T2 test was used to assess differences at the joint level, followed by post-hoc two-tailed t-tests for individual joint angles. RESULTS: The bladder exstrophy group showed more outwards foot progression, more hip adduction during stance and knee valgus during swing compared to controls. The bladder exstrophy group showed lower ankle push-off power compared to controls. Children with osteotomy surgery showed higher knee valgus throughout stance compared to the non-osteotomy group. CONCLUSION: The larger hip adduction and external foot progression in children with bladder exstrophy are most probably inter-related and a consequence of the anatomically wider pelvis. The lower ankle power push-off likely stems from the non-optimal gait pattern caused by deviations at the hip and foot. Osteotomy surgery has less impact on the gait pattern than initially anticipated.