toeing in/out
what is toeing out and what causes it?
is less common and can be caused by femoral retroversion, external tibial torsion, and flat feet
external tibial torsion correction has a high complication rate with surgery
what are the two types of clubfoot
what is genu valgum
excessive lateral tibial torsion, referred to as knock-knees; excessive lateral patellar positioning
what is the etiology of hip dysplasia
abnormality in the size, shape, orientation, or organization of the femoral head, acetabulum, or both
what is the etiology of transient synovitis
acute onset of sudden hip pain in children ages 3-10
transient inflammation of the synovium of the hip
what is the thigh foot angle
angle between axis of the foot and axis of thigh measured with child prone and knees at 90
describe postural clubfoot
from intrauterine malposition
abnormal development of the head and neck of the talus, due to hereditary or neuromuscular disorders
observed: PF, adducted, and inverted foot (postural)
what is genu varum
excessibe medial tibial torsion, referred to as bowlegs
what are the risk factors for hip dysplasia
females > males, breech position, family hx of hip dysplasia, low levels of amniotic fluid, swaddling an infant too tightly
what are some observations with children who have transient synovitis
what causes toeing in
common in W sitting
three types of deformity depending on the age of the child including metatarsus adductus, internal tibial torsion, and increased femoral anteversion
describe talipes equinovarus
plantar flexion at talocrural joint
inversion at subtalar, talocalcaneal, talonavicular, and calcaneocuboid joints
supination at midtarsals joints
at what age is the following normal?
newborn or infants
6-12 months of age
18-24 months
3-4 years
age 7
Genu varum is normal in newborn and infants.
Maximal varum present at 6–12 months of age
Lower limbs gradually straighten with a zero tibiofemoral angle by 18–24 months
Knees gradually drift into valgus and is maximal around 3–4 years with an average medial tibiofemoral angle of 12°
Genu valgum spontaneously corrects by age 7 to the adult alignment of lower limbs
what is included in the exam to dx hip dysplasia
barlow test, ortolani test, limited hip abduction, galeazzi sign, klisic sign
what are some imaging/tests we can use to help dx
biopsy/ ultrasonography shows effusion that causes bulging of the anterior joint capsule
what is the most common cause of in-toeing
internal tibial torsion
there is a high complication rate with osteotomy of tibia and is associated with W sitting
at birth and can be detected with prenatal ultrasound
thorough biomechanical lower quarter exam
affected foot is a half size smaller and less mobile; calf muscles will be smaller
50% can be bilaterally
what is the norm between male and female
8° of valgum in females and 7° in the male
what is the gold standard for treatment?
how should we maintain the positions of the hips
pavlik harness is gold standard
maintain the hip in flexion and abduction position to maintain femoral head in acetabulum; recommendation varies. 85-95% success rate with use in newborns to 6 months
what are the s/s
unilateral hip or groin pain
less common medial thigh or knee pain
crying at night
antalgic limp
pain no common
recent hx of upper respiratory tract infection
what is metatarsus adductus? who is affected by it the most? and what are the two types? what tx do we provide
most common congenital foot deformity;
greater occurrence in females and more common on the left side
Rigid: results in a medial subluxation of tarsometatarsal joints vs flexible: adduction of all five metatarsals at the tarsometatarsal joint
flexible tx strengthening and regaining proper alignment of the foot (use of orthoses)
what are some physical therapy goals for clubfoot
postural condition: manipulation followed by casting or splinting (ponseti method)
following casting, stretching is important. orthosis (denis-browne splints) throughout the day for up to 3 months and then at night for up to 3 years
talipes equinovarus (non postural) requires surgical intervetion to correct deformity followed by casting or splinting. Achilles' tenotomy may be necessary
what are some PT goals for angular conditions
decreased loading of knee while maintaing strength and endurance
what are some PT goals for hip dysplasia
moderate resistance exercise program, delay deformities, maximize function and patient education
what are some tx's and how long does it typically last
NSAIDs
rest while healing
last about 7-10 days