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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