At 03:23 21/10/99 -0700, you wrote:
>Does anyone one have suggestions for treatment of this little
>girl who has an anteverted NOF and whose (R) leg intoes quite
>considerably? she was refered to me by a podiatrist for physio
>after he inserted "gait plates" into her shoes, for soft tissue
>lengthening and strengthening. I have significantly improved
>her hip external ROM with various stretches and exercises but
>her mum has noticed that with a recent growth spurt the intoeing
>appears worse again. She appears to have poor control of her
>legs. I have done glut max and med strengthening with her.
>Suggestions please.
>Scott Epsley
>Physiotherapist
>Brisbane, Australia
>
>
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dear scott,
some of the normal kids never grow out of their "infantile" anteversion of
the femur, and so in trying to keep the head of the femur covered by the
acetabulum while weight bearing, they rotate the leg inward, with the
result of intoeing gait. years ago people used braces like "twister" to
force an outtoeing gait, but it did not work and even caused damage to the
hip joint. to find out the real cause for that kind of gait it is posible
to measure the anteversion by u.s, x-rays and also by simple clinical
assessment. no treatment is effective but derotation of the femur by
osteotomy (proximal, distal or other). this should be done after the age of
9 yrs which is the upper limit you allow for spontaneous changes. now it
seems a rather drastic approach, but if the the gait is mechanicaly
difficult and cosmeticaly disturbing, it is worth trying. in our department
we treated quite a number of youngsters (mainly girls) with good results
and good patient satisfaction. our role as p.t's was to work hard on the
muscles after the malrotation was corrected.
check for other reasons like internal rotation of the tibia.
netta harries
head of p.t services
rehabilitation centre and pediatric orthopedic ward
"assaf harofeh" medical centre
israel
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