LOWER EXTREMITY ROTATIONAL DEFORMITIES · LOWER EXTREMITY ROTATIONAL DEFORMITIES Martin J. Herman,...
Transcript of LOWER EXTREMITY ROTATIONAL DEFORMITIES · LOWER EXTREMITY ROTATIONAL DEFORMITIES Martin J. Herman,...
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LOWER EXTREMITY ROTATIONAL DEFORMITIES
Martin J. Herman, MD
Professor of Orthopedic Surgery and Pediatrics
Drexel University College of Medicine
Chief of Orthopedic Surgery
St. Christopher’s Hospital for Children
Philadelphia, PA, USA
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LE Rotational Deformities
• Common
problems
• Wide range of
diagnoses
• Most are
“normal”
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Chief Complaint
• What is the concern?
• Why is it a concern?
• Functional
• Cosmetic
• Future problems
“My mother-in-law thinks Jenny walks funny”
Eofdreams.com
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History
• Onset
• Milestones
• Functional problems?
• Pain?
CONSIDER other Diagnoses
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Examination
• Observational gait
analysis
• Rotational profile
• Angular deformities
ROTATIONAL PROFILE
Foot-progression angle
Hip rotation
Thigh-foot axis
Foot deformity
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Gait Analysis
• Observe walking and moving
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Foot - Progression Angle
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Hip Rotation
• Rotation » femoral version
• Anteversion = IR
• Retroversion = ER
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Thigh-Foot Axis
• Measure of tibial torsion
• Internal
• External
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Foot Deformities (Most Common)
• Metatarsus Adductus (in-toeing)
• Flexible Flatfeet (out-toeing)
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Angular Deformities
Scirp.org
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Natural History of Internal Tibial Torsion
• Spontaneously improves by age 4-6
• NO long-term sequelae
• Brace/therapy DO NOT alter natural
history
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Surgery for Internal Tibial Torsion After Age 9
• Asymmetry
• Functional concerns
• Tripping
• Physical appearance
Cut fibula for > 30° correction
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Natural History of Femoral Anteversion
• Spontaneously improves by age 10
• NO long-term sequelae
• Brace/therapy DO NOT alter natural
history
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Surgery for Femoral Anteversion after age 10
• Asymmetry
• Functional concerns
• COSMESIS• Midshaft osteotomy
• Correct rotation only
• Proximal or distal
osteotomy
• Correct rotation and
deformity
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Foot Deformities
• Metatarsus adductus
• Treat rarely (severe cases)
• 20% of adults have flatfeet
• MOST are minimally symptomatic
Lateral column lengthening after age 9
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Lower Extremity Rotational Deformities
• Remember:
• Evaluation
• Natural History
• MOST are NORMAL children
• Who needs surgery?
• Asymmetry
• Severe deformity