Foot rotation asymmetry in Down syndrome and the relationship with crawling and walking onset: a cross sectional study


  • Camila Valero Centro Universitário Saúde ABC
  • Zan Mustacchi Setor de Genética do Hospital Infantil Darcy Vargas, São Paulo/ SP, Brazil; Centro de Estudos e Pesquisas Clínicas (CEPEC) – São Paulo (SP), Brazil
  • Patricia Melo Bezerra Centro Universitário FMABC - Santo André/SP, Brazil
  • Francisco Winter dos Santos Figueiredo Departamento de Epidemiologia e Análise de Dados do Centro Universitário FMABC, Santo André/ SP, Brazil
  • Patricia Merly Martinelli Laboratório de Epidemiologia e Análise de Dados do Centro Universitário FMABC, Santo André, São Paulo, Brazil
  • Alzira Alves de Siqueira Carvalho Departamento de Neurologia do Centro Universitário FMABC, Santo André/SP, Brazil
  • David Feder Departamento de Farmacologia do Centro Universitário FMABC, Santo André/SP, Brazil.



Down syndrome, Gait, Locomotion, Motor skills, Posture


Introduction: Down syndrome individuals have different gait patterns, which include specific characteristics such as foot rotation asymmetry.

Objective: The aim of this study was to analyze the relationship between this asymmetry and the previous acquisition of hands-and-knees crawling in Down syndrome children, as well as the probable association of this gait to gender, ethnicity, comorbidities, physiotherapy, and occupational therapy interventions.

Methods: In this cross-sectional study, 361 children with or without foot rotation asymmetry were selected. An online questionnaire was administered to the parents or guardians of those children.

Results: Hands-and-knees crawling decreased the prevalence of foot rotation asymmetry in Down syndrome children. The longer it took for walking onset, the higher the prevalence of this asymmetry. Indeed, for each month of delay there was a 7% increase in prevalence. There was a significant relationship between orthopedic alterations in knees or flat feet and foot rotation asymmetry. There was no significance related to gender, ethnicity, other comorbidities, physiotherapy or occupational therapy interventions.

Conclusion: The findings in this study revealed that foot rotation asymmetry may be related to the acquisition of the motor skills described above, especially with regards to hands-and-knees crawling and walking onset.


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