When standing, patella
points inwards when
feet face forwards
Compensatory
external rotation
Testing
Hip
rotation
Internal
Normal: 20-60*
Anteversion:
>70*
External
Normal: 30--60*
Anteversion:
<20*
Treatment
SOFT TISSUE: Stretching
& excercises/activities.
AIM: increase
external rotation
of hip
Avoid 'W'
position? (not
proven)
DB Splints?
Spontaneous
correction
Femoral torsion
Testing
X-ray to see
this??
Treatment
Referral to surgical & MDT
May
spontaneously
resolve
If not resolved by
12 - derotational
osteotomy
The angle formed by
the axis through the
head and neck of the
femur and the
transcondylar line of
the distal femur
Normal values
Birth: 30*
Internal
Adult: 10*
internal
If the angle of torsion is
greater than normal (or
greater than 10* internal)
this would indicate a less
than norm al
developmental torsional
change, clinically this may
be a cause of intoeing
Foot/metatarsals
Pathology
Medial subluxation of
tarsometatarsal joints
With adduction &
inversion of all 5
metatarsals
Rearfoot in
neutral/varus
Classification: Bleck
Treatment
90% resolve
spontaneouslyy
If rigid refer for surgical correction
Flexible = serial casting
3-5 years old -abductor hallucis release
8+ multiple metatarsal osteotomies
Medial column lengthening &
lateral shortening
Tibial Torsion
A transverse
plane rotation of
the distal aspect of
the tibia relative to
the proximal
Testing
Clinically - measure malleolur position: bisection of the
lateral malleoli distally to the bisection of the tibia
proximal. Clinically measure the angle formed by the
bisection of the medial and lateral malleoli with respect
to the frontal plane
Treatment
Monitor & refer on to
surgical team
May spontaneously
resolve
Normal values:
Birth: 0*
Adult:
18-23*
external
Examination
Thigh - foot angle
Normal: 20* external rotation
bisection line should be in line
with buttoch <10* tibial torsion