The Therapeutic Effect of Tibia Counter Rotator With Toe-Out Gait Plate in the Treatment of Tibial Internal Torsion in Children

Abstract

ObjectiveTo evaluate the therapeutic effect of a Tibia Counter Rotator (TCR) with toe-out gait plate (GP) upon tibial internal torsion by a comparative analysis of transmalleolar angle (TMA) and gait analysis with GP alone.MethodsTwenty participants with tibial internal torsion were recruited for this study. Each 10 participants were included in group A with TCR and GP application and in group B with GP application only. The TMA and the kinematic results were used for the evaluation of the therapeutic effects of orthoses.ResultsWithin each group, TMA showed a significant increase after treatment. Group A showed a continuous improvement up to six months, however, group B showed an improvement up to five months only. Group A showed a significantly higher correction effect than group B after treatment. Regarding kinematic data, both groups showed a significantly decreased mean ankle adduction angle after treatment. However, group A showed a significantly lower mean ankle adduction angle than group B after six months.ConclusionThe group with TCR and GP showed a significantly better outcome and continued correction force compared to the group with GP only. Our results suggest that TCR with GP may be useful therapeutic orthoses for children with tibial internal torsion.

Efficacy of a Tibia Counter Rotator System for the Treatment of Internal Tibial Torsion in Children

“…A TMA less than 5° was defined as internal tibial torsion, and less than −20° was defined as severe in this study. The TMA is the angle measured using a gravity goniometer [2,8] between the line connecting the The TMA is the angle measured using a gravity goniometer [2,8] between the line connecting the points bisecting the medial tibial condyle and the line bisecting the lateral fibular condyle, while the knee is extended in the coronal plane in the supine position. Negative values indicate internal rotation of the tibia, and positive values indicate external rotation.…”

“…Subsequently, it improves spontaneously in the majority of children during postnatal development [ 1 ]. In East Asian countries with a floor-sitting culture, the number of children with internal tibial torsion is higher than in Western countries, since sitting directly on the floor disrupts the natural outward roll of the tibia [ 2 , 3 , 4 ]. Furthermore, rotating the legs inward in a prone position or sleeping with the hips and knees bent (knee-tuck position) may cause internal tibial torsion [ 4 ].…”

“…Later, a group in Korea developed a tibia counter rotator (TCR), a corrective orthosis based on the theory of this tibia torsional transformer. They also reported that the TCR in combination with a toe-out gait plate (GP) was effective in the treatment of internal tibial torsion [ 2 ]. However, the number of cases treated in that study was limited, and the outcomes after TCR treatment were still unclear.…”

“…Figure 1. (a) A photo of a gravity goniometer and measurement of the transmalleolar angle (TMA).The TMA is the angle measured using a gravity goniometer[2,8] between the line connecting the…”

Child with a Lower Extremity Trouble

“…Tibia Counter Rotator (TCR) ve toe-out gait plate (GP) in karşılaştırmasında GP'nin daha erken sonuç verdiği, TCR'ninse deformiteyi düzeltmede daha etkili olduğu bildirilmiştir. [16] Şekil 17. TCR ve GP, Son, S.M., et al, The therapeutic effect of tibia counter rotator with toe-out gait plate in the treatment of tibial internal torsion in children.…”