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06/25/2013 Stanley Beekman, DPM
Tibial Torsion and Femoral Anteversion
I would like to add a few things that I have picked up during my years in practice. I find that “tibial torsion” is a positional deformity at the knee. Not only can the tibia flex relative to the femur, but it can also rotate relative to the femur. The internal rotation of the tibia is accompanied by an inversion (going into varus). Denis-Browne splints work well up to the age of three. I still bend them as was taught by Herman Tax, DPM to prevent pronation. At age three, I find that the children can untie double knots, so this appears to be the upper age limit for using them.
I find that internal femoral position most commonly is a result of missing the sitting phase at about six months. This important phase happens just prior to crawling. At this time the child develops balance centered around the hips. Also with the missing of sitting, the child kneels instead of sits when on the ground. The combination of the physical and neurological deficiencies results in child that has difficulty in walking and toes in. When this child starts to walk he/she cannot stick out their bottom to land on it. Instead the balance point is the knee, which can only flex. This results in the child falling on his/her knees and then forwards onto their face, or falling backwards.
In addition to stretching and gait plates, and monitoring sitting positions, I also have the mother work with the child doing some simple seated balance exercises. The easiest way to do this is to have the mother place the child on the ground in a cross legged seated position and then roll a ball to the child and have the child roll the ball back. During this session, have the mother roll the ball to the left side, and then to the right side of the child so the child has to side bend to catch the ball. I find that it only takes a week or two to correct the balance issue.
Stanley Beekman, DPM, Cleveland, OH, sbkmn1@gmail.com
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