In-toe gait examination

NewsBot · Apr 18, 2012

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Relationship between Physical Examinations and Two-Dimensional Computed Tomographic Findings in Children with Intoeing Gait.
Kim HD, Lee DS, Eom MJ, Hwang JS, Han NM, Jo GY.
Ann Rehabil Med. 2011

OBJECTIVE:
To evaluate the validity of physical examinations by assessment of correlation between physical examinations and CT measurements in children with intoeing gait and the causes of intoeing gait by age using CT measurements.

METHOD:
Twenty-six children with intoeing gait participated in this study. The internal and external hip rotation, thigh-foot angle and transmalleolar angle were measured. In addition, femoral anteversion and tibial torsion of the subjects were assessed using a CT scan. The measurements of torsional angles were performed twice by two raters. The correlation coefficients between physical examinations and CT measurements were calculated using Pearson correlation. The data was analyzed statistically using SPSS v12.0.

RESULTS:
The correlation coefficients between physical examinations and CT measurements were not high. Before 5 years of age, intoeing gait was caused by femoral anteversion in 17.86%, tibial torsion in 32.29% and the combination of causes in 35.71% of cases. After 6 years of age, the contributions changed to 29.17%, 8.33% and 45.83%, respectively.

CONCLUSION:
Before 5 years of age, the common cause of an intoeing gait was tibial torsion, whereas after 6 years of age it was femoral anteversion. Regardless of age, the most common cause of intoeing gait was a combination of causes. This study shows poor correlation between physical examinations and CT. Therefore, it is limiting to use physical examination only for evaluating the cause of intoeing gait in clinical practice
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NewsBot · Jul 20, 2013

The physiological range of femoral antetorsion
Sebastian Decker, Eduardo M. Suero, Nael Hawi, Christian W. Müller, Christian Krettek
Skeletal Radiology; July 2013

Introduction
Intramedullary nailing is a common method for fixation of femoral diaphyseal shaft fractures. However, postoperative malrotation does occur in 20–30 % of patients, as intraoperative assessment of antetorsion remains difficult. The estimated average antetorsion angle is 15°. However, it is not clear whether antetorsion correlates with individual characteristics such as age, gender, or femoral length. This information may help surgeons to better estimate the correct target rotation before and during surgery.

Materials and methods
The antetorsion of 211 healthy femurs was measured using torsion difference CTs according to the technique published by Jend. Correlations with age, gender, and femoral length were calculated.

Results
A significant negative correlation of age and antetorsion was found for women aged 0–20. Older women and men did not show any correlation between antetorsion and age. There was no correlation between antetorsion and femoral length. Mean values differed between 17.8° ± 8.9° and 22.7° ± 10.7° in women and 15.3° ± 8.0° and 21.4° ± 9.7° in men.

Conclusions
Antetorsion is mostly independent of body height and age, the latter except in women younger than 20. The so-far-estimated physiologic antetorsion of about 15° seems to be a little higher in most people.
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NewsBot · Apr 21, 2022

Evaluation of Postural Control in Children With Increased Femoral Anteversion
DenizTUNCER et al
Gait & Posture 16 April 2022

Highlights
•Postural control components are important for the activity level of daily living.
•The study examines the effect of increased femoral anteversion on postural control.
•Increased femoral anteversion causes poor postural stability and balance.
•Further research is required to examine and prevent postural control impairment.
•To our knowledge current study is the first in the literature.
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Background
Femoral anteversion is defined as the angular difference between the axis of the femoral neck and the transcondylar axis of the knee and the most common cause of an in-toe gait in children.

Research question
Does increased femoral anteversion (IFA) adversely affect postural stability and balance in healthy children?

Methods
Sixteen children with IFA aged 10-15 years and an age-matched control group of 16 children who were growing typically were included. Postural stability (PS), limits of stability (LoS), and the modified clinical test of sensory integration of balance (mCTSIB) were used to evaluate postural control by "Biodex Balance System® (BBS)" and Balance Error Scoring System (BESS), which is a visual observation of instability in 3 stance positions under 6 different conditions, were performed for all cases. SPSS v.20 program was used for data analysis. Independent Samples T-test or Mann Whitney U test were used for between-group comparisons depending on the distribution properties of the data. The significance level was set at p < 0.05.

Results
A significant difference was found between the groups for overall and anterior/posterior stability index in PS (p < 0.05), all parameters of LoS (p < 0.05) and mCTSIB (p < 0.05). Also there was a significant difference between the BESS firm surface (p = 0.007), BESS foam surface (p < 0.001), and total surface scores (p < 0.001).

Significance
The results indicate that the children with IFA were significantly more unstable in all parameters of BBS and BESS when compared to their healthy peers. This shows that postural stability and balance are impaired in healthy children with IFA. To the extent of our knowledge, this study is the first to examine the postural control problems associated with IFA in healthy children.
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NewsBot · Oct 4, 2022

Hawthorne Effect in Gait Analysis of Children with In-Toeing Caused by Increased Femoral Anteversion
Ahmet Hamdi Akgülle et al
Indian J Orthop. 2022 Aug 30;56(10):1789-1794

Background: In-toeing is one of the main reasons children are applying to the orthopedics clinic. In the clinical settings, during in-toeing gait assessment parents often define that their child does not walk same at the clinic as at home, linked possibly to Hawthorne effect.

Research question: How does the in-toeing angle differ when children are aware, versus when they are not aware of their gait inspection?

Methods: This single center, clinical, cross-sectional, observational study looked into the variation in gait pattern of twelve children with in-toeing, with and without their awareness. Two videos for each child was recorded with a smart phone, once at the clinic while aware and once by the family without awareness, and uploaded into Kinovea software for gait analysis. The angle of foot in-toeing was measured and analyzed using SPSS comparison of means and correlations.

Results: The gait pattern evaluated with the angle of in-toeing showed a significant difference between the two videos of the same child. The angle difference returned a p value of 0.000 using paired sample t test and a Cohen's d value of 1.4, representing the large significance between clinic and family recorded videos. The initial foot in-toeing angle showed a moderate positive Pearson's correlation of 0.031 when compared with the angle difference in both settings.

Significance: These results highlight the importance of including family recorded videos in gait pattern analysis without the patient's awareness. The study not only shows the significant difference found which can be explained by Hawthorne Effect but also suggests a clearer path of understanding the child's condition with the family.
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