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Paeds Rotational Profile
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- Internal tibia torsion
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- Humans are not born walking unlike other animals
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- In femoral anteversion, GT is positioned more posteriorly, thus the child internally rotates the lower limb to brings the GT forward to maximise the length muscle tension of the gluteus medius muscle
- Thus, the child may walk like normal; so ask the child to run, it will unmask the internal rotation
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- “I will do a Staheli Rotational Profile Assessment”
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- Walk the patient
- [-5 - 20 degrees]
- Increased femoral ante version ➔ Intoeing gait
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- Prone position, knee flexed to 90 degrees
- One hand over GT; slowly internally rotate the hip (drop the foot outwards)
- Angle from vertical to palpation of GT at its MOST prominence = ante version angle [20-60 degrees]
- Anteversion about 40 ° at birth and goes to 16 ° at 16 yo.
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- Prone with knee flexed to 90 [10-20 °]
- Angle look at is the transcondylar axis of proximal tibia and the bimalleolar axis
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- Normally passes through 2nd web space
- Mild = thru 3rd toe
- Moderate = 3/4 webspace
- Severe 4/5 webspace
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- Not accurate because it is affected by the calcaneum shape/ morphology
- So to remove the influence of the heel, I can use the trans malleolar axis instead of the axis of the foot.
- The TMA method has a higher test reliability and validity
Tibial_Torsion_in_Cerebral_Palsy_Validity_and_Reli.pdf344.7KB
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- 4/6/9 from smallest to biggest bone
- Metatarsus Adductus - Most resolve by 4years
- Internal Tibia Torsion - Most resolve at 6 yo. 90% at 6 yo
- If op = Derotational supramalleolar osteotomy
- Femoral anteversion - most resolve 90% at 9 years
- If op - derotational femoral osteotomy
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- Plagiocephaly
- Congenital muscular torticollis
- DDH
- Posteromedial tibia bowing
- Metatarsus Adductus
- Calcaneovalgus foot
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- Berg classification
- Simple
- Complex = MTA + lateral shift of midfoot
- Skew Foot = MTA + valgus hindfoot
- Complex Skew Foot aka Serpentine Foot = MTA + Lateral shift + Valgus hindfoot (both complex and skew)
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- Opening wedge and closing wedge osteotomy
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- In patients with non ambulatory, or walking abnormally, then wolves law cannot work, and thus, remodelling does not occur to correct rotation. e.g. cerebral palsy
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Tip Toe Walker
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- Neurologic causes - e.g. Subtle CP especially if unilateral, Spinal Dysraphism
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- Ask to walk with feet flat. Change habit
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Paediatrics Apophysitis
- Osgood-Schlatter = Microavulsion caused by repeated traction of the anterior portion of the developing ossification of tuberosity
- Sinding-Larson-Johanssen = Traction tendinitis of the inferior pole of patella
- Jumper’s knee = patellar tendonitis
- Clergyman’s knee = infra patellar bursitis
- Housemaid’s knee = pre patellar bursitis
- Sever’s Disease = Traction apophysitis of calcaneal apophysis
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Growing pain
- Growing pains?
- Diagnosis of exclusion; cause unknown; age 3 or so. pain mainly at night; episodes for years; self limiting
- Walk up and down 3 times
- Heel to toe walking (tandem gait) to assess coordination
- Squat and stand - proximal myopathy
- Sit and look for rotational profile
- Touch the ankle and the knee - make sure not warm or swollen