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Rotational profile of the lower limb in 1319 healthy children
Michel Jacquemier, Yann Glard, Vincent Pomero, Elke Viehweger, Jean-Luc Jouve, Gérard Bollini
Gait and Posture (in press)

 

Gait deviations and compensations in pediatric patients with increased femoral torsion
Marina Bruderer-Hofstetter, Verena Fenner, Erika Payne, Katja Zdenek, Harry Klima andRegina Wegener
Journal of Orthopaedic Research Volume 33, Issue 2, pages 155–162, February 2015

 

In-Toeing Is Often a Primary Care Orthopedic Condition
John A. Sielatycki, MD, William L. Hennrikus, MD, , Richard D. Swenson, MD, Matthew G. Fanelli, BS, Cynthia J. Reighard, CRNP, Jane A. Hamp, RN
The Journal of Pediatrics; 25 July 2016

 

The rotational profile: a study of lower limb axial torsion, hip rotation, and the foot progression angle in healthy adults
David Hudson et al
Gait and Posture; Article in Press

 

When talking about torsion, is this the same as rotation? If so, is it internal or external rotation? Just graduated so want to be clear when I'm reading so I don't get confused. Thanks and please be kind with answers!

 

Hi Katrina,
No they aren't the same.

Rotation is when you turn something or you ask your patient to turn it. So the example is that you would internally or externally rotate the hip to see how much movement there is.

Torsion however is twist in the bone. You can have internal or external torsion, as a clinician you can measure it how much there is but it is the bone position therefore you can't move it or do much about it.


When a child presents with intoe gait - it is commonly called a rotational deformity as the gait looks internally rotated on it's axis and when you assess the hip, tibia and foot, you find it is resultant from tibial torsion. Here is nice little explanation with pictures: http://eorthopod.com/rotational-deformities-in-children/

Hope that helps.

 

Thank you that is very helpful.
So their bone has not fully twisted into the correct position during development - (is it foetal development that is the problem?). Will it twist itself eventually or is it a permanent deformity?
By looking at the child, you would describe it as a rotational deformity - I suppose it would take X-Ray's to find out specifically if it was the bone?
Is the tx different for rotation than for torsion?
Sorry, I'll have a look at the video - I always have more questions than answers :-/
THanks again for your time in explaining something which is probably really basic!!
Katrina

 

Babies are born with very different rotational profiles as toddlers, teenagers and adults. As part of the growth process the bone shape, length and torsion changes. If you have a read of some of the above articles, they describe those changes over time.

X-rays are rarely needed and even then, CT is a better assessment and only done for surgical planning. You use internal and external hip rotation to assess hip, you use a foot thigh angle to assess the tibia and blecks to assess the amount of metatarsus adductus. The three areas that commonly cause rotational problems.

The foot commonly changes up to the age of 6, the tibia up to the age of 8 and the femur, up to the age of 12.

Treatment is then based on the presentation and area but to drill it right down:
1. Metatarsus adductus - no treatment if it is fully correctible, semi-flexible - splinting/casting, rigid surgery
2. Tibial torsion - no conservative treatment works - only surgery and only when outside the normal range.....this is the same with hips.

 

thanks for your time and direction. Very helpful :)

 

Is in-toing gait physiological in children? - Results of a large cohort study in 5910 healthy (pre-) school children
Ronald Verch et al
Gait and Posture; Article in Press

 

Compensatory mechanisms in children with idiopathic lower extremity internal rotational malalignment during walking and running
S. KimberlyByrnes et al
Gait & Posture 16 April 2020