aDductory twist post heel lift

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Any advice appreciated.

A 10 y/o female pt, c/o generalised b/below knee 'pains' post w/bing > 1hr. Med Hx includes congenital talipes ? (mother can't remember). Pt attends "Little Athletics" and had recent lateral ankle sprain whilst attempting a high jump.
I could only perceive, in the gait analysis, the rearfoot remained in a pronated position throughout contact, forefoot pushoff over 1st mpj's, heel lift seemed ok timing wise, and there was a b/massive aDuctory twist of foot (b/heels lateral moving) on heel lift. Supination resistance test >> moderate to heavy resistance. Otherwise, apart from lack of tib torsion L/tibia, nad.
Why the significant aDductory twist? thanks, mark c

 

G'day Mark,

Adductory twist is an interesting one, check for femoral anteversion. Might be a late midstance firing of internal hip rotators or a weakness of glut. medius or glut. minimus. She may still be evolving gait, as lower limb mechanics don't always mature to an adult gate in some cases into adolescence, so check on her developmental history and the developmental history of her peers and parents. Full gait analysis is really important here, as well as hip range and quality of motion assessment. The rearfoot pronation may be compensation for the internal position, as the forefoot abducts to bring the foot plantargrade. Also check family history for CP, and if she may have had talipies, she may have also has congental hip dysplasia.
Lots and lots of internal rotator stretching at the hips, external hip rotator strengthening, and at the risk of getting a caining from everyone else here... gait plates temporarily?

-Adrian

 

Did you mean peers or siblings?

Encourage crossed leg sitting and activities such as ice skating, roller blades etc. which will tend toward external rotation of the hip. Ballet?

 

Peers should have read siblings yes, and yeah things like cross legged sitting, hip adductor strecthing, will help with the tight internal roatators, and single leg squats will help with glut med/minimus. Any of these activies would be good. I also use 'duck walking', where the child is instructed to consiously walk with the lower limbs externally rotated for 5-10 mins 2-3 times a day