Toe walking

They usually occur in 3’s... sometimes 4’s

This 12 year old obligate toewalker was brought to our office by his mom for an evaluation. Many times with neurological issues people will have concomitant musculoskeletal abnormalities. It probably has something to do with chromosome 6...

Here we explain three common congenital abnormalities occurring together

#gait #gaitevaluation #internaltibialtorsion #femoralretroversion #femoralretrotorsion #forefootadductus #metatarsusadductus #clinicalexam 

Bilateral femoral retro torsion

It’s difficult to see from the angle of the camera that this patient has bilateral femoral retro torsion. It’s pretty obvious he has a difficult time balancing on one leg.  Both of his knees point to the outside when he standing straight. He also has bilateral internal tibial torsion so he needs to turn his feet out to have a normal progression angle for gait.

Notice when he does the one leg standing test how much he has to hike his hips, particularly the right hip when he is weight-bearing on the left side. Also note the position of the knee of the weight bearing side. “Knees pointing out”  is often a telltale sign of femoral retro torsion which often occurs concurrently with internal tibial torsion. This patient also has a Forefoot adductus.

The strategy is he has to get his weight over his hip and it’s very difficult when it has to be externally rotated. Rotate your right foot out and balance on your right leg trying not to lean your torso over the hip and you’ll see what we’re talking about

#gait #gaitexam #internaltibialtorion #femoralretrotorsion #femoralretroversion #forefootadductus #clinicalexam

The unhappy triad

The unhappy triad?

-internal tibial torsion, femoral retro torsion, tibial varum. We often see these three things occurring together which can create patellar tracking problems or, as in this lower back pain. We know that things often occur in threes and congenital abnormalities are no different. 

–The femoral retro torsion limit internal rotation of the hip so when that foot is planted on the ground, the patient rotates to that side, the hip stops and the lumbar spine keeps going. 

–The lumbar spine should only have about 5° of rotation from top to bottom so this often puts undue stress into the lumbar spine resulting in lower back pain.

The remedy?

– Things which we can do to utilize or help internal rotation of the hips such as chair exercises with internal rotation, the 90/90 seated stretch as well as patient education to keep shoulders and hips in the same plane when rotating or carrying a load as well as externally rotating the foot when spinning to that side (To create the range of motion that is not available).

#itt #internaltibialtorsion #internaltibialrotation #femoralretroversion #femoralretrotorsion #limitedhipmotion #gait #tibialvarum 

Valgus Posts

A valgus post on an orthotic is a useful tool when you are trying to get weight off of the lateral and onto the medial column of the foot. It works best with people that have adequate range of motion in the first ray complex (they can get the head of the big toe to the ground) because if you don’t have adequate range of motion, you will only force the knee to the midline which sometimes can cause patellofemoral problems.

A valgus post as a post which begins wider laterally and narrows medially. It usually begins near the tubercle of the fifth metatarsal and can extend as far up as the end of the fifth toe. The idea is as you walk across the post, it forces the foot from lateral to medial helping to sink the first ray down to the ground. It functions similar to a first ray cut out (A notch cut out of the orthotic at the head of the first metatarsal) however is generally more gradual and sometimes better tolerated.

This type of posting is often used in people with internal tibial torsion who often having a difficult time getting weight onto the first right and keeping the knee in the sagittal plane.

In this video we briefly describe how the posting works. 

6th Toe Disease

It’s probably fair to say that a good number of us see people with “sixth toe” problems or a Taylor’s bunion more often than not. This problem is often accompanied by internal tibial torsion and sometimes femoral retro torsion. This video reviews a case that came in yesterday.

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#6thtoe #6thtoedisease #tailorsbunion #lateralfootpain #footpain #footproblem #gait