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Infant lower extremity examination

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Infant lower extremity examination American College of Osteopathic Pediatricians Robert W Hostoffer, DO FACOP edited by Eric Hegybeli, DO, FACOP – PowerPoint PPT presentation

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Title: Infant lower extremity examination


1
Infant lower extremity examination
  • American College of Osteopathic Pediatricians
  • Robert W Hostoffer, DO FACOP

edited by Eric Hegybeli, DO, FACOP
2
Background
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.
3
Background
  • 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.

4
Background
  • 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

5
Causes of Intoe Gait

Causes of Intoe Gait                            
                 
6
Normal - - - - - - - Intoe Gait
  •  

Normal - - - - - - - Intoe Gait  
                                            
7
Metatarsus 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).

9
Causes 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.

10
Treatment
  • observation, for those with a supple, or
    flexible, forefoot
  • passive osteopathic manipulation exercises
  • casts
  • surgery

11
Tibiofemoral Angle
12
Salenius 1975
13
Internal Tibial Torsion
14
Internal 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

15
Thigh-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

16
Thigh Foot Angle

Thigh Foot Angle                                
             
17
External Tibial Torsion
18
Excess Femoral Anteversion
19
Femoral Anteversion

Femoral Anteversion                            
                 
20
Barlow Ortolani Tests
21
Print out the answer sheet to use with the
following questions.
22
Circle 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.

23
Questions
  • 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

24
Question
  • 2. Abnormal thigh-foot angle
  • A. -40
  • B. 45
  • C. -45
  • D. -35
  • E. -30

25
Question
  • 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

26
Certificate of Completion
  • I, _________________________, successfully
    completed the Pediatric OMT Module on __ __ 20__
  • Signatures
  • Pediatric Resident ____________________
  • Pediatric Residency Director____________
  • ( Please print and give to program director.)

27
Congratulations
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