Rotational Deformity Exam

NHx

 

In-toeing is normal up til 8 - 10 years

- combination ITT / PFA

- anteversion decreases, ETT increases

 

Causes Intoeing

 

PFA

- usually symmetrical

- unilateral consider CP

 

ITT

- usually asymmetrical

 

Foot

- metatarsus adductus

- CTEV

- metatarsus primus varus

- skewfoot

 

Causes out-toeing

 

ETT

- usually unilateral

- consider NM cause i.e. CP, SB

 

SUFE

 

Examination

 

Staheli's Torsional Profile

 

Look

 

Squinting patella

- rotation above patella, in femur

 

Foot Progression angle

- Us 10° out (0°-30°) 

 

Prone

 

Foot

- curved lateral border

- heel bisector should pass through second MT

 

Thigh- Foot Angle TFA

- knees flexed

- Reconstruct foot

- Usually 15° (0°-30°) ER

 

Transmalleolar Axis (TMA)

- knees flexed

- Usually 0 - 30° ER

 

Hip Internal Rotation

- Usually < 65° 

- > 70° = FAV

 

Gage's trochanteric angle

- GT most prominent laterally

- angle of tibia from verticle

 

Hip External Rotation

- Usually 40° (20-60°)

- Greater in young child

- Note IR + ER should  = 90°