More on the “little guy”

We have been following this little guy for some time now. If you have not been keeping up, perhaps you should read herehere and here 1st. 

So, what do we see in these latest pictures?

Top left: neutral view.

  • He enjoys flip flops; probably not the best thing for a developing kiddo, in light of the excessive engagement of the posterior compartment (and reciprocal inhibition of the anterior compartment)
  • he has some tibial varum (ie bowleggedness) L > R
  • he has some developmental genu valgum whnich appears to be improving (need a Q angle review? click here)
  • no tibial torsion present on L: for a review on torsions, click here
  • still some external tibial torsion present on R (see section below on middle shots)

Top right and bottom: full internal rotation of R thigh: compare with bottom: full internal rotation of L thigh

  • he has adequate internal rotation (4 degrees needed) but not as great as left side (see bottom shot); this represents some improvement since we started
  • he has generous internal rotation of the left thigh

Middle Left: full external rotation of right thigh

  • note the position of the knee and the position of the foot; external tibial torsion is present. for a review of torsions, click here.
  • he has limited external rotation of the right thigh (compared with the left. The knee should fall more outside the saggital plane

Middle right: full external rotation of the left thigh

  • note the position of the knee and the position of the foot; internal tibial torsion is present. 
  • he has generous external rotation of the left thigh (compared with the left)

of other significant note: most of his calcaneal valgus has resolved; longitudinal arches are improved.

What now?

  • He continues to develop normally and continues to improve since his original presentation to the office
  • Having the child continue to walk barefoot
  • Continue to wear shoes with little torsional rigidity, to encourage additional additional intrinsic strength to the feet
  • He should continue to limit “W” sitting, as this will tend to increase the genu valgus present
  • We reviewed 1 leg balancing “games” and encouraged continuing agility activities, like balance beam, hopping, skipping and jumping on each leg individually
  • added in using a push and pedal bike
  • added in heel walking exercises

Ivo and Shawn. Bald. Good looking. Extraordinary Gait Geeks. Taking the world of gait literacy by storm with each and every post.