Genu Varum

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Hello,

Today I had a 5 year old girl present with moderate-severe intoeing. She is currently under speech pathology as she is slow to talk with stuttering and her mother reports she is behind other children at her gym, ofter falling, poor balance and tripping.

On assessment of her gait 100% of steps were intoeing with neither leg more dominant than the other, each side changing with severity at each step. Her jumping was rhymic but not on the spot, hopping she was able to hop 5 times on the right but not at all on the left. she was able to run on her toes. Interestingly to note that when runing both feet had improved alignment.

Internal hip rotation was good but external hip rotation was restricted with the hip in flexion. No met adductus present. Without x-ray there appears to be genu varum. Her gait is heel to toe and although she is pronating it does not appear to be excessive, and improves with her steps that are in better alignment.

Sleeping/sitting positions have been discussed with the clients mother previously and they have rectified the sitting position by verbal and physical (sitting crossed legged- mother supporting from behind). she is wearing good boots that have velro fastening.

I would appreciate any tips for management of this child. I feel that foot orthoses/gait plates may not provide any correction for her as the genu varum and internal rotation appear to be the causative factors. I intend to discuss with our physio's a more structure stretching program but would like to hear if anyone else has any other tips on treatment. Should i be getting an xray?

 

G'Day...

The intoeing and mild pronation at (I'm assuming midstance...) is expected developmentally at this age, however the tripping and falling generally isnt. What age did the child walk, talk, crawl etc. What were the scores for the child at birth? I'd also be considering the possibilty of delayed development disorter, or perhaps mild cerebral palsy. Perhaps suggest to the parent that an appoiontment with a paediatrician might be useful. I'd also be looking at suggestions with gait pattern, get the child to consiously lift their knees more, it will make them more aware of their own walking. Failing this, a SOFT lateral midfoot (cuboid) filler in the shoes may be of assistance, as it may trigger proprioceptive feedback and get the proneals firing slightly earlier, which will help to stabilize the lateral column.

Worth a try?