Title: Infant lower extremity examination
1Infant lower extremity examination
- American College of Osteopathic Pediatricians
- Robert W Hostoffer, DO FACOP
edited by Eric Hegybeli, DO, FACOP
2Background
Andrew Taylor Still, was born in Virginia in
1828, the son of a Methodist minister and
physician. At an early age, Still decided to
follow in his father's footsteps as a physician.
After studying medicine and serving an
apprenticeship under his father, Still became a
licensed M.D. in the state of Missouri. Later, in
the early 1860's, he completed additional
coursework at the College of Physicians and
Surgeons in Kansas City, Missouri. He went on to
serve as a surgeon in the Union Army during the
Civil War.
3Background
- After the Civil War and following the death of
three of his children from spinal meningitis in
1864, Still concluded that the orthodox medical
practices of his day were frequently ineffective,
and sometimes harmful. He devoted the next ten
years of his life to studying the human body and
finding better ways to treat disease.
4Background
- His research and clinical observations led him to
believe that the musculoskeletal system played a
vital role in health and disease and that the
body contained all of the elements needed to
maintain health, if properly stimulated. Still
believed that by correcting problems in the
body's structure, through the use of manual
techniques now known as osteopathic manipulative
treatment, the body's ability to function and to
heal itself could be greatly improved. He also
promoted the idea of preventive medicine and
endorsed the philosophy that physicians should
focus on treating the whole patient, rather than
just the disease. - http//www.aacom.org/OM/history.html
5Causes of Intoe Gait
Causes of Intoe Gait                           Â
                Â
6Normal - - - - - - - Intoe Gait
Normal - - - - - - - Intoe Gait Â
                                           Â
7Metatarsus Adductus
8- Metatarsus adductus, also known as metatarsus
varus, is a common foot deformity noted at birth
that causes the front half of the foot, or
forefoot, to turn inward. Metatarsus adductus may
also be referred to as "flexible" (the foot can
be straightened to a degree by hand) or
"non-flexible" (the foot cannot be straightened
by hand).
9Causes of Metatarsus Adductus
- The cause of metatarsus adductus is not known. It
occurs in approximately one out of 1,000 live
births and affects girls and boys equally.Other
causal factors include the following - family history of metatarsus adductus
- position of the baby in the uterus, especially
with breech presentations - sleeping position of the baby (babies sleeping on
their stomach may increase the tendency of the
feet to turn inward) - Babies born with metatarsus adductus may also be
at increased risk of having an associated hip
condition known as developmental dysplasia of the
hip (DDH). DDH is a condition of the hip joint in
which the top of the thigh (femur) slips in and
out of its socket, because the socket is too
shallow to keep the joint intact.
10Treatment
- observation, for those with a supple, or
flexible, forefoot - passive osteopathic manipulation exercises
- casts
- surgery
11Tibiofemoral Angle
12Salenius 1975
13Internal Tibial Torsion
14Internal Tibial Torsion
- Internal Tibial Torsion (ITT) is a condition in
early childhood in which the tibia (leg bone) is
twisted inwards axially, causing the child to
intoe as he walks. This is a very common
condition -and considered normal unless it does
not resolve beyond 18 to 24 months of age. ITT is
universal in infants and toddlers, and when the
child takes his first steps, intoeing is the
norm. With walking, the ITT resolves, and
disappears by 18 to 24 months of age. - Osteopathically, internal rotation of the tibia
is caused by a dropped navicular (causes
excessive pronation of the foot) internal
rotation of the tibia could be a cause of ITT
15Thigh-Foot angle
- In a child 18 months of age, it should be between
-10 degrees to 10 degrees. - worse than -45 degrees should be treated
16Thigh Foot Angle
Thigh Foot Angle                               Â
            Â
17External Tibial Torsion
18Excess Femoral Anteversion
19Femoral Anteversion
Femoral Anteversion                           Â
                Â
20Barlow Ortolani Tests
21Print out the answer sheet to use with the
following questions.
22Circle the correct answer and review with
director
- Question1 A, B, C, D, E.
- Question2 A, B, C, D, E.
- Question3 A, B, C, D, E.
23Questions
- 1. Reasons for intoeing in the pediatric patient
- A. Femoral anteversion
- B. Internal tibial torsion
- C. Metatarsus abductus
- D. External tibial torsion
- E. Otarnis inversion
24Question
- 2. Abnormal thigh-foot angle
- A. -40
- B. 45
- C. -45
- D. -35
- E. -30
25Question
- 3. The following are causes of metatarsus
adductus except - A. Sleeping position
- B. In utero position
- C. family history of MA
- D. Sleeping on stomach
- E. Dysplasia of the hip
26Certificate of Completion
- I, _________________________, successfully
completed the Pediatric OMT Module on __ __ 20__ - Signatures
- Pediatric Resident ____________________
- Pediatric Residency Director____________
- ( Please print and give to program director.)
27Congratulations