Rotational profile of the lower extremity and foot progression angle: computerized tomographic examination of 50 male adults

Seber, Sinan; Hazer, Bülent; Köse, Nüsret; Göktürk, Erol; Günal, İzge; Turgut, Akin

doi:10.1007/s004020050459

Cited by 69 publications

(46 citation statements)

References 16 publications

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“…13,48,79 Our mean hip anteversion values are within the range of normal values reported in healthy adults (7°-18°), as measured by both clinical and diagnostic methods. 8,36,63,65,71,72 Our findings of greater hip anteversion in females as compared to males agree with those of other studies 8,63 ; but the magnitude of the sex difference is much larger in the current study (approximately 9° versus 2°-4°). This disparity may be explained by differences in measurement methods, as the previous studies report measures on cadavers or with ultrasound and the current study used clinical measures in healthy subjects.…”

Section: Hip Anteversionsupporting

confidence: 90%

Sex Differences in Clinical Measures of Lower Extremity Alignment

Nguyen¹,

Shultz²

2007

J Orthop Sports Phys Ther

167

135

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Selected lower limb injuries and, in particular, those of the knee have been reported to occur in greater prevalence in females compared to males. 4,29,49,60,61,85 Sex differences in lower extremity alignment (LEA) have been included among a myriad of risk factors as a potential cause for the prevalence of knee injury in females. 21,29,34,33,47 Anecdotally, females have been cited as having greater anterior pelvic tilt, femoral anteversion, tibiofemoral angle, quadriceps angle, genu recurvatum, tibial torsion, and foot pronation. 21,29 However, apart from the measure of quadriceps angle, there is little empirical data to support these sex differences in a healthy population.While the literature consistently demonstrates greater mean quadriceps angles in females, 1,23,24,26,28,84 limited studies support a sex difference in mean pelvic tilt 24 and genu recurvatum. 81 Conversely, no sex differences have been observed with measures of tibial torsion 57,77 and foot pronation as measured by navicular drop 6,24,51,81 t StuDy DeSign: Descriptive, cohort design.t ObJectiveS: To comprehensively examine sex differences in clinical measures of static lower extremity alignment (LEA).t bAckgrOunD: Sex differences in LEA have been included among a myriad of risk factors as a potential cause for the increased prevalence of knee injury in females. While clinical observations suggest that sex differences in LEA exist, little empirical data are available to support these sex differences or the normal values that should be expected in a healthy population.t MethODS AnD MeASureS: The right and left static LEA of 100 healthy college-age participants (50 males [mean 6 SD age, 23.3 6 3.6 years; height, 177.8 6 8.0 cm, body mass, 80.4 6 11.6 kg] and 50 females [mean 6 SD age, 21.8 6 2.5 years; height, 164.3 6 6.9 cm; body mass, 67.4 6 15.2 kg]) was measured. Each alignment characteristic was analyzed via separate repeated-measures analyses of variance, with 1 between-subject factor (sex) and 1 within-subject factor (side).t reSultS: There were no significant sex-byside interactions and no differences between sides. Females had greater mean anterior pelvic tilt, hip anteversion, quadriceps angles, tibiofemoral angles, and genu recurvatum than males (P<.0001). No sex differences were observed in tibial torsion (P = .131), navicular drop (P = .130), and rearfoot angle (P = .590).t cOncluSiOn: Sex differences in LEA indicate that females, on average, have greater anterior pelvic tilt, thigh internal rotation, knee valgus, and genu recurvatum. These sex differences were not accompanied by differences in the lower leg, ankle, and foot. Understanding these collective sex differences in LEA may help us to better examine the influence of LEA on dynamic lower extremity function and clarify their role as a potential injury risk factor.

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Section: Hip Anteversionsupporting

confidence: 90%

Sex Differences in Clinical Measures of Lower Extremity Alignment

Nguyen¹,

Shultz²

2007

J Orthop Sports Phys Ther

167

135

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“…Our data for MatGrp 2 (mean SD, 14.1° 5.9°; range, 6°-30°) are in line with those reported for 13 to 16 year olds in 2 of these studies (means ranging from 8° to 20°), 21,82 and our values in MatGrp 3 (10.9° 5.0°; range, -2.2°-21°) appear to be consistent with those obtained in healthy adult males and females (means ranging from 7° to 18°) using both clinical and imaging measurement methods. 10,38,54,60,61,66,68 However, our values for MatGrp 1 are substantially lower than those reported elsewhere. 21,78,82 Although using 2 testers introduces the potential for systematic differences between testers, 71 each tester measured subjects in all maturation groups; so it is unlikely that systematic measurement error alone explains these disparate findings.…”

Section: Methodscontrasting

confidence: 82%

Differences in Lower Extremity Anatomical and Postural Characteristics in Males and Females Between Maturation Groups

Shultz¹,

Nguyen²,

Schmitz³

2008

J Orthop Sports Phys Ther

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Descriptive, cross-sectional.We compared lower extremity anatomical characteristics in males and females between different maturation groups.Sex differences have been observed in lower extremity anatomical characteristics. While the reasons contributing to these sex differences in adults are unknown, there is evidence that anatomy and posture change considerably during growth and development.One hundred seventy-three young athletes (age range, 9-18 years) were assessed for stage of maturation and placed into 1 of 3 groups, according to Tanners stages 1 and 2 (MatGrp 1 ), 3 and 4 (MatGrp 2 ), and 5 (MatGrp 3 ). Participants were measured for pelvic angle, hip anteversion, quadriceps angle, tibiofemoral angle, femur length, tibial length, genu recurvatum, tibial torsion, navicular drop, general joint laxity, and anterior knee laxity. Data were compared by sex and maturation group.When comparing maturation groups, limb length, pelvic angle, and tibial torsion increased with maturation, and anterior knee laxity, genu recurvatum, tibiofemoral angle, and foot pronation decreased with maturation. Females had greater general joint laxity, hip anteversion, and tibiofemoral angles, and shorter femur and tibial lengths than males, regardless of maturation group. Maturational changes in knee laxity and quadriceps angles were sex dependent.We observed a general change in posture with maturation that began with greater knee valgus, knee recurvatum, and foot pronation in MatGrp1, then moved toward a relative straightening and external rotation of the knee, and supination of the foot in later maturation groups. While the majority of the measures changed similarly in males and females across maturation groups, decreases in quadriceps angles and anterior knee laxity were greater in males compared to females, and females were observed to have a more inwardly rotated hip and valgus knee posture, compared to males, particularly in later maturation groups.Diagnosis, level 4.

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“…A study using CT to measure the transmalleolar axes of 504 adult tibiae found a discrepancy of 3.4˚ between right and left sides, with the right being the more external (Strecker et al 1997). Seber (2000) did not find any significant difference between left and right tibial torsion in 50 healthy male participants according to CT. Krishna et al (1991) Only those trials with a knee ab/adduction range of less than 16i ncluded. Pelvic protraction, internal hip rotation, external hindfoot-thigh angle, external transmalleolar axis, internal foot progression angle, and internal knee progression angle are positive.…”

Section: Discussionmentioning

confidence: 84%

Passive and dynamic rotation of the lower limbs in children with diplegic cerebral palsy

Linden¹,

Hazlewood

Hillman

et al. 2006

Developmental Medicine &Amp; Child Neurology

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Rotation characteristics in gait and passive rotation of the lower limbs were evaluated retrospectively in 105 patients with diplegic cerebral palsy (65 males, 40 females; mean age 13y [SD 6y 9mo]; range 4y 4mo-40y 5mo). Of 105 patients, 22 (20.9%) required crutches, sticks, tripods, or a K-walker for their daily ambulation. Twelve (11.5%) patients used a wheelchair or buggy for community distances, e.g. shopping. Significant differences in rotational characteristics were found at the pelvis, hip, knee, and foot between left and right legs. Patients who were more affected on the right (group R, n=33) or the left side (group L, n=39) were re-evaluated. There was also a group of patients who were not asymmetrically affected (group S, n=33). In group L, maximum passive internal rotation was significantly greater on the left side, while no difference between the sides was found in group R. Peak internal rotation in gait was significantly higher on the right side in group R, but did not differ significantly between the sides in group L. Right hindfoot-thigh angle and transmalleolar axis were more external on the right, irrespective of which leg was more affected. These findings may have implications for the early non-operative management of limb posture in infants with diplegia and the surgical management of established lower extremity malrotation.

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Rotational profile of the lower extremity and foot progression angle: computerized tomographic examination of 50 male adults

Cited by 69 publications

References 16 publications

Sex Differences in Clinical Measures of Lower Extremity Alignment

Sex Differences in Clinical Measures of Lower Extremity Alignment

Differences in Lower Extremity Anatomical and Postural Characteristics in Males and Females Between Maturation Groups

Passive and dynamic rotation of the lower limbs in children with diplegic cerebral palsy

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