Lower-extremity rotational problems in children. Normal values to guide management.

Staheli, Lynn T.; Corbett, Margery; Wyss, C R; King, Helen Dean

doi:10.2106/00004623-198567010-00006

Cited by 508 publications

(396 citation statements)

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“…Physical examinations were performed with patients in the prone position, and details of measurements were as follows: (1) TFA: With the patient's knee flexed 90°, the ankle in the neutral position, and the sole parallel to the floor, the angle between the longitudinal axis of the thigh and longitudinal axis of the foot were measured. A negative angle means internal rotation and a positive angle external rotation [21] (Fig. 1); (2) TMA: With the patient in the position described previously for TFA, the TMA was measured between the line of the longitudinal axis of the thigh and the line perpendicular to the axis that connected the most prominent portions of the medial and lateral malleolus [21] (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…A negative angle means internal rotation and a positive angle external rotation [21] (Fig. 1); (2) TMA: With the patient in the position described previously for TFA, the TMA was measured between the line of the longitudinal axis of the thigh and the line perpendicular to the axis that connected the most prominent portions of the medial and lateral malleolus [21] (Fig. 2); (3) second toe test: With the patient's knee fully extended, the lower extremity was rotated internally or externally until the second toe pointed directly toward the floor.…”

Section: Methodsmentioning

confidence: 99%

“…Since Staheli et al described rotational profile, TFA and TMA have been used predominantly to measure tibial torsion [20,21]. In patients with CP and myelomeningocele, to eliminate external tibial torsion, tibial derotation osteotomy frequently is performed [4-6, 19, 22].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Tibial Torsion in Cerebral Palsy: Validity and Reliability of Measurement

Lee¹,

Chung²,

Park

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Physical examinations of tibial torsion are used for preoperative planning and to assess outcomes of tibial osteomy in patients with cerebral palsy (CP). The thigh-foot angle (TFA) and transmalleolar axis (TMA) are commonly used, and the second toe test recently was introduced. However, the validity and reliability of the three methods have not been clarified. This study was performed to evaluate the validity and reliability of these physical measures. We recruited 18 patients (36 limbs) with CP. During reliability sessions, three raters with various levels of orthopaedic experience independently measured tibial torsion using the three different methods during one day before surgery. Validity was assessed by performing a correlation study between physical examination and two-dimensional computed tomographic (CT) findings. Interobserver reliability was greatest for the TMA followed by TFA and then by the second toe test with intraclass correlation coefficients of 0.92, 0.74, and 0.57, respectively. In terms of the concurrent validity, the correlation coefficients (r) for the CT measurements were 0.62, 0.52, and 0.55. When depicting tibial torsion by physical examination, all three methods had substantial validity, but test reliability and validity were highest for TMA measurements.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Tibial Torsion in Cerebral Palsy: Validity and Reliability of Measurement

Lee¹,

Chung²,

Park

et al. 2009

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…However, because both hip rotations were low and this outcome was only observed in cases with poor and moderate clinical results, we thought that it might be associated with stiffness in the hip. The thigh-foot angle and the transmalleolar axis angle reflect tibial and hindfoot rotation [2,[4][5][6]. The present study shows that tibial and hindfoot rotation were normal in infants.…”

Section: Discussionmentioning

confidence: 79%

“…At present, these deformities can be gauged by a number of electronic techniques including tomography, facilitating the determination and evaluation of variations. Few studies have been published on lower extremity rotational deformities, and these have been done on children with no concurrent pathology [1][2][3][4][5][6][7][8]. Staheli et al [5] established the lower extremity rotational profiles of normal children, providing the clinician with a more objective and quantitative standard of measurement.…”

Section: Introductionmentioning

confidence: 99%

Post therapeutic lower extremity rotational profiles in children with DDH

Arslan

Ersöz

Kişin

et al. 2008

Journal of Children's Orthopaedics

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Purpose The purpose of this study was to investigate post-therapeutic lower extremity rotational profiles in children with developmental dislocation of the hip (DDH), the differences between these values and those of normal children, and the relationship between these differences and clinical and radiological results. Methods In 82 lower extremities of 64 patients, the footprogression angle was measured clinically and the transmalleolar axis angle photographically, and hip rotations and thigh-foot angle were measured both clinically and photographically. The data obtained were compared with Staheli's data for normal children. In addition, clinical and radiographic data were compared within subgroups and with Staheli's data. Student's t-test and one-way ANOVA were used for statistical evaluation. Results The medial rotation of the hip, the average clinical value was 44.668, and the photographic value was 42.288. Lateral rotation of the hip, the average clinical value was 38.018, and the average photographic value was 37.298. Thigh-foot angle, his angle was clinically 8.238 and photographically 9.688. Angle of the transmalleolar axis, the photographic average was 21.598. Foot-progression angle, the clinical average was 10.708. It was determined that the lower extremity rotational profiles of children with DDH treated after walking did not differ from those of normal children, but that the internal and external hip rotations of McKay type III and IV patients were below those of normal children and of McKay type I and II patients. ConclusionLower extremity rotational profiles in children with DDH who received appropriate treatment were the same as those for normal children.

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Bones of the Lower Limb

Haffner

Conklin

2016

Bergman's Comprehensive Encyclopedia of Human Anatomic Variation

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Lower-extremity rotational problems in children. Normal values to guide management.

Cited by 508 publications

References 0 publications

Tibial Torsion in Cerebral Palsy: Validity and Reliability of Measurement

Tibial Torsion in Cerebral Palsy: Validity and Reliability of Measurement

Post therapeutic lower extremity rotational profiles in children with DDH

Bones of the Lower Limb

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