A New Instrument for Measuring Tibial Torsion in Pediatric Patients

Abstract

ObjectiveTo develop and test the validity and reliability of a new instrument for measuring the thigh-foot angle (TFA) for the patients with in-toeing and out-toeing gait.MethodsThe new instrument (Thigh-Foot Supporter [TFS]) was developed by measuring the TFA during regular examination of the tibial torsional status. The study included 40 children who presented with in-toeing and out-toeing gaits. We took a picture of each case to measure photographic-TFA (P-TFA) in the proper position and to establish a criterion. Study participants were examined by three independent physicians (A, B, and C) who had one, three and ten years of experience in the field, respectively. Each examiner conducted a separate classical physical examination (CPE) of every participant using a gait goniometer followed by a TFA assessment of each pediatric patient with or without the TFS. Thirty minutes later, repeated in the same way was measured.ResultsLess experienced examiner A showed significant differences between the TFA values depending on whether TFS used (left p=0.003 and right p=0.008). However, experienced examiners B and C did not show significant differences. Using TFS, less experienced examiner A showed a high validity and all examiner's inter-test and the inter-personal reliabilities increased.ConclusionTFS may increase validity and reliability in measuring tibial torsion in patients who has a rotational problem in lower extremities. It would be more useful in less experienced examiners.

Assessment of lower limbs in people with Generalized Joint Hypermobility (GJH) - preliminary report

“…In this study, there were no significant differences in tibial torsion in people with GJH compared to the control groups. Similar results were obtained by Jeon et al [19]. The high values of standard deviation (SD) indicate the high individual variability of the tibial torsion in participants.…”

“…In the literature, no studies were found about the assessment of the rotation in the hip joints, the axis of the lower limbs, tibial torsion, and arches of feet in subjects with GJH at different ages. This issue seems to be important for posturology and the causes of gait disorders [19]. Sass et al [33] claimed that rotational and angular disorders of the lower limbs are the most common disorders in children whose therapy is based on conservative treatment.…”

“…Researcher #2 measured the axis of rotation of the goniometer on the calcaneus, the fixed arm along the long axis of the thigh, and the mobile one pointing between the 2nd and 3rd metatarsal bones [17,19,20]. c. the axis of the lower limbs.…”

“…Increased range of internal rotation may be the cause of the in-toeing gait. It was found that despite numerous publications, the reason of in-toeing gait is still unknown [19]. The most common cause is forefoot adduction, an increase of internal tibial torsion, and femoral anteversion [33].…”

Comparison of multiple flatfoot indicators in 5–8-year-old children

“…The angle between the second ray and the thigh axis was regarded as the thigh-foot angle. The negative value refers to the internal rotation of the tibia, whereas the positive value refers to the external rotation [ 20 ]. For the femoral torsion deformity, internal and external hip rotation was measured with the patient prone and the knees flexed to 90°.…”