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
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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.
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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.

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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

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Causes of Intoe Gait

Causes of Intoe Gait                            
                 
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Normal - - - - - - - Intoe Gait

•  

Normal - - - - - - - Intoe Gait  
                                            
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Metatarsus Adductus
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• 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).

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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.

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Treatment

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

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Tibiofemoral Angle
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Salenius 1975
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Internal Tibial Torsion
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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

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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

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Thigh Foot Angle

Thigh Foot Angle                                
             
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External Tibial Torsion
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Excess Femoral Anteversion
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Femoral Anteversion

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

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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

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Question

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

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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

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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.)

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Congratulations