Toe walking

They usually occur in 3’s... sometimes 4’s

This 12 year old obligate toewalker was brought to our office by his mom for an evaluation. Many times with neurological issues people will have concomitant musculoskeletal abnormalities. It probably has something to do with chromosome 6...

Here we explain three common congenital abnormalities occurring together

#gait #gaitevaluation #internaltibialtorsion #femoralretroversion #femoralretrotorsion #forefootadductus #metatarsusadductus #clinicalexam 

Bilateral femoral retro torsion

It’s difficult to see from the angle of the camera that this patient has bilateral femoral retro torsion. It’s pretty obvious he has a difficult time balancing on one leg.  Both of his knees point to the outside when he standing straight. He also has bilateral internal tibial torsion so he needs to turn his feet out to have a normal progression angle for gait.

Notice when he does the one leg standing test how much he has to hike his hips, particularly the right hip when he is weight-bearing on the left side. Also note the position of the knee of the weight bearing side. “Knees pointing out”  is often a telltale sign of femoral retro torsion which often occurs concurrently with internal tibial torsion. This patient also has a Forefoot adductus.

The strategy is he has to get his weight over his hip and it’s very difficult when it has to be externally rotated. Rotate your right foot out and balance on your right leg trying not to lean your torso over the hip and you’ll see what we’re talking about

#gait #gaitexam #internaltibialtorion #femoralretrotorsion #femoralretroversion #forefootadductus #clinicalexam

Can you say Forefoot Adductus?

-Take a look at these tootsies. Draw an imaginary lines for the center of the hill: this should normally pass up through the foot either through the second metatarsal or between the second and third. Can you see how the foot is somewhat banana shaped?

– This is also called metatarsus adductus. The deformity is at the apex of the tarsal/metatarsal joint, also known as Lisfranc joint. The fifth metatarsal base is often prominent in the foot is convex in shape with a higher arch.

-This is usually caused by intrauterine positioning and if caught early will usually spontaneously resolve. Since this gal is over 34, that’s probably not her reality. It is interesting to note that along with this congenital deformity, hip dysplasia and internal tibial torsion (which she has) are extremely common.

– Gait abnormalities seen with this include a decreased progression angle, and a propulsive gait often secondary to poor intrinsic function of the foot musculature

#forefoot #forefootadductus #adductus #foot #footproblem #gait #clinicalexam #thegaitguys