Ann Rehabil Med.  2011 Aug;35(4):491-498. 10.5535/arm.2011.35.4.491.

Relationship between Physical Examinations and Two-Dimensional Computed Tomographic Findings in Children with Intoeing Gait

• Kim HD
• Lee DS
• Eom MJ
• Hwang JS
• Han NM
• Jo GY

• KMID: 1971714
• DOI: http://doi.org/10.5535/arm.2011.35.4.491

Abstract

OBJECTIVE
To evaluate the validity of physical examinations by assessment of correlation between physical examinations and CT measurements in children with intoeing gait and the causes of intoeing gait by age using CT measurements. METHOD: Twenty-six children with intoeing gait participated in this study. The internal and external hip rotation, thigh-foot angle and transmalleolar angle were measured. In addition, femoral anteversion and tibial torsion of the subjects were assessed using a CT scan. The measurements of torsional angles were performed twice by two raters. The correlation coefficients between physical examinations and CT measurements were calculated using Pearson correlation. The data was analyzed statistically using SPSS v12.0.
RESULTS
The correlation coefficients between physical examinations and CT measurements were not high. Before 5 years of age, intoeing gait was caused by femoral anteversion in 17.86%, tibial torsion in 32.29% and the combination of causes in 35.71% of cases. After 6 years of age, the contributions changed to 29.17%, 8.33% and 45.83%, respectively.
CONCLUSION
Before 5 years of age, the common cause of an intoeing gait was tibial torsion, whereas after 6 years of age it was femoral anteversion. Regardless of age, the most common cause of intoeing gait was a combination of causes. This study shows poor correlation between physical examinations and CT. Therefore, it is limiting to use physical examination only for evaluating the cause of intoeing gait in clinical practice.

Keyword

Intoeing gait; Femoral anteversion; Tibial torsion; Thigh foot angle; Hip internal rotation

MeSH Terms

Child
Gait
Hip
Humans
Physical Examination

Figure

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  Fig. 1 Gravity goniometer.

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  Fig. 2 Lower extremities fixation brace was used for evaluation of intoeing gait children by CT.

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  Fig. 3 The reference lines are the bisection line of femoral head and neck and the line of femoral condyles as described by Weiner et al.8 The angle between these two planes show femoral anteversion.

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  Fig. 4 The reference line is the posterior border of the proximal tibial plateau, and the bisection line of the distal tibial plateau through the center of the fibula. The angle of these two line results in tibial torsion.

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  Fig. 5 Scatter plot of relationship between physical examinations and CT measurements (A: relationship between femoral anteversion and hip internal rotation, B: relationship between femoral anteversion and hip external rotation, C: relationship between tibial torsion and thigh-foot angle, D: relationship between tibial torsion and transmalleolar angle).

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