Causes of Intoeing Gait in Children with Cerebral Palsy

Rethlefsen, Susan A.

doi:10.2106/jbjs.e.01280

Cited by 38 publications

(24 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We agree with others (Arnold et al 2000, Rethlefsen et al 2006, Lovejoy et al 2007) that soft tissue surgery should not be recommended to correct pronounced internal rotation, as this is almost universally associated with bony deformity rather than with spastic muscles alone and need rotational osteotomy for adequate correction. Even so, in more moderate rotational deformities and when there is doubt as to whether to perform a large operation including bony surgery, an improvement in rotational deformities can be expected as a side effect following soft tissue procedures aimed at correction of deformities in the sagittal plane.…”

Section: Discussionsupporting

confidence: 76%

See 1 more Smart Citation

Changes in lower limb rotation after soft tissue surgery in spastic diplegia

Lofterød

Terjesen

2010

Acta Orthopaedica

View full text Add to dashboard Cite

Background and purpose Rotational osteotomies are usually necessary to correct pronounced rotational deformities in ambulant children with cerebral palsy. The effects of soft tissue surgery on such deformities are unclear. In this retrospective study, we determined whether multilevel soft tissue surgery, performed to correct deformities in the sagittal plane, would also have an effect on rotational parameters.Patients and methods We examined 28 ambulant children with spastic diplegia with an average age of 12 (7–19) years. They underwent multilevel soft tissue surgery (with 6 surgical procedures per child on average). 3-dimensional gait analysis was performed preoperatively and at an average follow-up of 1–2 years. The indications for surgery were abnormalities in the sagittal plane. Gait analysis data from healthy children were used in defining normal ranges of kinematic variables. For assessment of changes in the transverse plane, the angles of foot progression, hip rotation, and pelvic rotation were studied.Results The transverse plane kinematic results showed no statistically significant postoperative changes when the preoperative parameters were within the normal range (within 2 SD of the mean of the normal material). In limbs where the preoperative values were abnormal (more than 2 SD above the normal mean), there was a mean reduction in internal foot progression of 12° (p = 0.01) and a mean reduction in external pelvic rotation of 6° (p = 0.02). The effect was more pronounced in children under 12 years of age. Internal hip rotation was not significantly reduced.Interpretation When the preoperative rotational parameters were abnormal, multilevel soft tissue surgery resulted in improved transverse plane kinematics. This could be of importance in preoperative decision making, especially when there is doubt as to whether to include rotational osteotomies in multilevel operations in younger children.

show abstract

Section: Discussionsupporting

confidence: 76%

“…Thus in-toeing was considerably more frequent than out-toeing. Rethlefsen et al (2006) found that in-toeing was most often associated with increased internal hip rotation. We found no statistically significant preoperative correlations between foot progression and either hip rotation or pelvic rotation.…”

Section: Discussionmentioning

confidence: 96%

Changes in lower limb rotation after soft tissue surgery in spastic diplegia

Lofterød

Terjesen

2010

Acta Orthopaedica

View full text Add to dashboard Cite

show abstract

“…Children with in-toeing gait who visited the outpatient clinic of the university hospital were included in this study if they met the following criteria: (1) hip internal rotation ≥60° and trochanteric prominence angle ≥20° [2818], (2) bilateral involvement, (3) age over 8 years, (4) symptoms, frequent tripping and fatigue like pains, (5) symptom duration ≥1 year, and (6) no effect from previous rehabilitation therapy such as gait plate and home stretching programs, received for at least an year prior to participation in this study. For trochanteric prominence angle measurement, children's knees were flexed to 90° in prone position.…”

Section: Methodsmentioning

confidence: 99%

“…The exclusion criteria were: (1) internal tibial torsion (thigh-foot angle of <0° [825]), (2) metatarsus adductus (adduction of the forefoot without varus was clinically assessed), (3) injury or surgery of the lower limb, (4) serious deformities of the lower limb that would affect gait, and (5) neurodevelopmental disorders, such as cerebral palsy or intellectual disability. For the thigh-foot angle, the angle formed by each line that divides the longitudinal axis of the thigh and calcaneus was measured in prone position with the knees bent 90° and the ankle in the neutral position using goniometer.…”

Section: Methodsmentioning

confidence: 99%

“…Increased femoral anteversion angle is defined as an increased angle at the intersection of an imaginary transverse line that runs medially through the knee joint and an imaginary transverse line passing through the centre of the femoral head and neck [78]. Muscle, either by its contractile force or by its passive elastic connective tissue, contributes towards the greatest torsional stress on bone [9].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Therapeutic Effect of Microcurrent Therapy in Children With In-toeing Gait Caused by Increased Femoral Anteversion: A Pilot Study

et al. 2017

View full text Add to dashboard Cite

ObjectiveTo investigate the efficacy of portable microcurrent therapy device (PMTD) of the hip internal rotators in the treatment of in-toeing gait caused by increased femoral anteversion in children over 8 years of age.MethodsEleven children (22 legs; 4 boys and 7 girls; mean age, 10.4±1.6 years) with in-toeing gait caused by increased femoral anteversion were included in the present study. All children received 60 minutes of PMTD (intensity, 25 µA; frequency, 8 Hz) applied to the hip internal rotators daily for 4 weeks. Hip internal rotation (IR) angle, external rotation (ER) angle, and midmalleolar-second toe angle (MSTA) measurement during stance phase at transverse plane and Family Satisfaction Questionnaire, frequency of tripping and fatigue like pains about the PMTD were performed before treatment and at 4 weeks after initial PMTD treatment. Paired t-test and Fisher exact test were used for statistical analysis.ResultsHip IR/ER/MSTA was 70.3°±5.4°/20.1°±5.5°/–11.4°±2.7°, and 55.7°±7.8°/33.6°±8.2°/–2.6°±3.8° before treatment and at 4 weeks after initial PMTD treatment, respectively (p<0.01). Ten of 11 (91%) children's family stated that they were generally satisfied with the PMTD treatment. The frequency of tripping and fatigue like pains was significantly lower at 4 weeks after PMTD treatment (p<0.05). Excellent inter-rater and intra-rater reliability was observed for repeated MSTA measurements between the examiners (k=0.91–0.96 and k=0.93–0.99), respectively.ConclusionPMTD of the hip internal rotators can be effective in improving the gait pattern of children with in-toeing gait caused by increased femoral anteversion.

show abstract

Structural Alterations in Muscle in Children with Spastic Cerebral Palsy

Dayanidhi

2022

Spasticity and Muscle Stiffness

View full text Add to dashboard Cite

Causes of Intoeing Gait in Children with Cerebral Palsy

Cited by 38 publications

References 20 publications

Changes in lower limb rotation after soft tissue surgery in spastic diplegia

Changes in lower limb rotation after soft tissue surgery in spastic diplegia

Therapeutic Effect of Microcurrent Therapy in Children With In-toeing Gait Caused by Increased Femoral Anteversion: A Pilot Study

Structural Alterations in Muscle in Children with Spastic Cerebral Palsy

Contact Info

Product

Resources

About