Stanley, Kevin et al
I can accept that if you apply an external torque to the lower limb, once the hip has reached it's end ROM and the knee has been externally rotated as far as it's soft tissue structure and bony architecture will allow it, you will eventually apply an external torque to the proximal end of the tibia, but where does your 'correction' take place?
Stanley, you feel that the external rotation occurs at the knee, could you further explain this?
My concern is that in applying an external torque in the lower limb, where in a young child the acetabulum in relation to the head and neck of femur is in an externally rotated position, which subsequently reduces form 60 degrees to approx 10 degrees ext. rotated, what effect this external torque will have on the natural ontogenic development? The knees being in a flexed position will allow further external rotation at the knee, but surely the force will be applied along the path of least resistance i.e. the hip!
I find it very diffficult to comprehend the use of a "splint" in which there is no evidence to support it's use, and I do not doubt that lower limb external rotation occurs, but I find it unlikely to have occured within the tibia. For example a gait plate can alter an intoeing gait pattern by altering the line of progression, but it does not solve the underlying pathology.
respectfully
Tony Achilles
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