Torsion of the lower limb in children


Key articles

Staheli LT. Rotational problems in children. Instr Course Lect. 1994;43:199-209. Abstract

Staheli LT, Corbett M, Wyss C, et al. Lower-extremity rotational problems in children: normal values to guide management. J Bone Joint Surg Am. 1985 Jan;67(1):39-47. Abstract

Reference articles

1. Staheli LT. Rotational problems in children. Instr Course Lect. 1994;43:199-209. Abstract

2. Staheli LT, Corbett M, Wyss C, et al. Lower-extremity rotational problems in children: normal values to guide management. J Bone Joint Surg Am. 1985 Jan;67(1):39-47. Abstract

3. Engel GM, Staheli LT. The natural history of torsion and other factors influencing gait in childhood: a study of the angle of gait, tibial torsion, knee angle, hip rotation, and development of the arch in normal children. Clin Orthop Relat Res. 1974 Mar-Apr;(99):12-7. Abstract

4. Hensinger RN. Standards in orthopedics: tables, charts, and graphs illustrating growth. New York, NY: Raven Press; 1986.

5. Jacquemier M, Glard Y, Pomero V, et al. Rotational profile of the lower limb in 1319 healthy children. Gait Posture. 2008 Aug;28(2):187-93. Abstract

6. Reeder BM, Lyne ED, Patel DR, et al. Referral patterns to a pediatric orthopedic clinic: implications for education and practice. Pediatrics. 2004 Mar;113(3 Pt 1):e163-7.Full text  Abstract

7. Cheng JC, Chan PS, Chiang SC, et al. Angular and rotational profile of the lower limb in 2,630 Chinese children. J Pediatr Orthop. 1991 Mar-Apr;11(2):154-61. Abstract

8. Craxford AD, Minns RJ, Park C. Plantar pressures and gait parameters: a study of foot shape and limb rotations in children. J Pediatr Orthop. 1984 Aug;4(4):477-81. Abstract

9. Losel S, Burgess-Milliron MJ, Micheli LJ, et al. A simplified technique for determining foot progression angle in children 4 to 16 years of age. J Pediatr Orthop. 1996 Sep-Oct;16(5):570-4. Abstract

10. Dias LS, Jasty MJ, Collins P. Rotational deformities of the lower limb in myelomeningocele: evaluation and treatment. J Bone Joint Surg Am. 1984 Feb;66(2):215-23. Abstract

11. Fraser RK, Menelaus MB. The management of tibial torsion in patients with spina bifida. J Bone Joint Surg Br. 1993 May;75(3):495-7.Full text  Abstract

12. Wren TA, Rethlefsen S, Kay RM. Prevalence of specific gait abnormalities in children with cerebral palsy: influence of cerebral palsy subtype, age, and previous surgery. J Pediatr Orthop. 2005 Jan-Feb;25(1):79-83. Abstract

13. Rethlefsen SA, Healy BS, Wren TA, et al. Causes of intoeing gait in children with cerebral palsy. J Bone Joint Surg Am. 2006 Oct;88(10):2175-80. Abstract

14. Laplaza FJ, Root L, Tassanawipas A, et al. Femoral torsion and neck-shaft angles in cerebral palsy. J Pediatr Orthop. 1993 Mar-Apr;13(2):192-9. Abstract

15. Robin J, Graham HK, Selber P, et al. Proximal femoral geometry in cerebral palsy: a population-based cross-sectional study. J Bone Joint Surg Br. 2008 Oct;90(10):1372-9. Abstract

16. Lampert C, Thomann B, Brunner R. Tibial torsion deformities. Orthopade. 2000 Sep;29(9):802-7. Abstract

17. Sutherland DH, Schottstaedt ER, Larsen LJ, et al. Clinical and electromyographic study of seven spastic children with internal rotation gait. J Bone Joint Surg Am. 1969 Sep;51(6):1070-82. Abstract

18. Steel HH. Gluteus medius and minimus insertion advancement for correction of internal rotation gait in spastic cerebral palsy. J Bone Joint Surg Am. 1980 Sep;62(6):919-27. Abstract

19. Chong KC, Vojnic CD, Quanbury AO, et al. The assessment of the internal rotation gait in cerebral palsy: an electromyographic gait analysis. Clin Orthop Relat Res. 1978 May;(132):145-50. Abstract

20. Joseph B. Treatment of internal rotation gait due to gluteus medius and minimus overactivity in cerebral palsy: anatomical rationale of a new surgical procedure and preliminary results in twelve hips. Clin Anat. 1998;11(1):22-8. Abstract

21. Crane L. Femoral torsion and its relation to toeing-in and toeing-out. J Bone Joint Surg Am. 1959 Apr;41-A(3):421-8. Abstract

22. Altinel L, Kose KC, Aksoy Y, et al. Hip rotation degrees, intoeing problem, and sitting habits in nursery school children: an analysis of 1,134 cases. Acta Orthop Traumatol Turc. 2007;41(3):190-4. Abstract

23. Kim HD, Lee DS, Eom MJ, et al. Relationship between physical examinations and two-dimensional computed tomographic findings in children with intoeing gait. Ann Rehabil Med. 2011 Aug;35(4):491-8.Full text  Abstract

24. Svenningsen S, Terjesen T, Auflem M, et al. Hip rotation and in-toeing gait: a study of normal subjects from four years until adult age. Clin Orthop Relat Res. 1990 Feb;(251):177-82. Abstract

25. Davids JR, Davis RB. Tibial torsion: significance and measurement. Gait Posture. 2007 Jul;26(2):169-71. Abstract

26. Davids JR, Davis RB, Jameson LC, et al. Surgical management of persistent intoeing gait due to increased internal tibial torsion in children. J Pediatr Orthop. J Pediatr Orthop. 2014 Jun;34(4):467-73 Abstract

27. Krackow KA, Mandeville DS, Rachala SR, et al. Torsion deformity and joint loading for medial knee osteoarthritis. Gait Posture. 2011 Apr;33(4):625-9. Abstract

28. MacWilliams BA, McMulkin ML, Baird GO, et al. Distal tibial rotation osteotomies normalize frontal plane knee moments. J Bone Joint Surg Am. 2010 Dec 1;92(17):2835-42. Abstract

29. Turner MS, Smillie IS. The effect of tibial torsion of the pathology of the knee. J Bone Joint Surg Br. 1981;63-B(3):396-8. Abstract

30. Yagi T. Tibial torsion in patients with medial-type osteoarthrotic knees. Clin Orthop Relat Res. 1994 May;(302):52-6. Abstract

31. Eckhoff DG. Effect of limb malrotation on malalignment and osteoarthritis. Orthop Clin North Am. 1994 Jul;25(3):405-14. Abstract

32. Eckhoff DG, Johnston RJ, Stamm ER, et al. Version of the osteoarthritic knee. J Arthroplasty. 1994 Feb;9(1):73-9. Abstract

33. Trost J. Physical assessment and observational gait analysis. In: Gage JR, ed. The treatment of gait problems in cerebral palsy. London, UK: Mac Keith Press; 2004:79-80, 187, 212.

34. Somerville EW. Persistent foetal alignment of the hip. J Bone Joint Surg Br. 1957 Feb;39-B(1):106-13.Full text  Abstract

35. Schwartz M, Lakin G. The effect of tibial torsion on the dynamic function of the soleus during gait. Gait Posture. 2003 Apr;17(2):113-8. Abstract

36. Coon V, Donato G, Houser C, et al. Normal ranges of hip motion in infants six weeks, three months and six months of age. Clin Orthop Relat Res. 1975 Jul-Aug;(110):256-60. Abstract

37. Hoffer MM. Joint motion limitation in newborns. Clin Orthop Relat Res. 1980 May;(148):94-6. Abstract

38. Siegel DB, Kasser JR, Sponseller P, et al. Slipped capital femoral epiphysis: a quantitative analysis of motion, gait, and femoral remodeling after in situ fixation. J Bone Joint Surg Am. 1991 Jun;73(5):659-66. Abstract

39. Song KM, Halliday S, Reilly C, et al. Gait abnormalities following slipped capital femoral epiphysis. J Pediatr Orthop. 2004 Mar-Apr;24(2):148-55. Abstract

40. Post WR, Teitge R, Amis A. Patellofemoral malalignment: looking beyond the viewbox. Clin Sports Med. 2002 Jul;21(3):521-46, x. Abstract

41. Cooke TD, Price N, Fisher B, et al. The inwardly pointing knee: an unrecognized problem of external rotational malalignment. Clin Orthop Relat Res. 1990 Nov;(260):56-60. Abstract

42. Halpern AA, Tanner J, Rinsky L. Does persistent fetal femoral anteversion contribute to osteoarthritis?: a preliminary report. Clin Orthop Relat Res. 1979 Nov-Dec;(145):213-6. Abstract

43. Flandry F, Hughston JC. Complications of extensor mechanism surgery for patellar malalignment. Am J Orthop. 1995 Jul;24(7):534-43. Abstract

44. James SL. Chondromalacia of the patella in the adolescent. In: Kennedy JC, ed. The injured adolescent knee. Baltimore, MD: Williams & Wilkins; 1979:205-251.

45. Stefko RM, de Swart RJ, Dodgin DA, et al. Kinematic and kinetic analysis of distal derotational osteotomy of the leg in children with cerebral palsy. J Pediatr Orthop. 1998 Jan-Feb;18(1):81-7. Abstract

46. Rerucha CM, Dickison C, Baird DC. Lower extremity abnormalities in children. Am Fam Physician. 2017 Aug 15;96(4):226-33.Full text  Abstract

47. The Easter Seal Society. The Easter Seal guide to children's orthopaedics: prevention, screening and problem solving. 2008 (originally published 1982) [internet publication].Full text

48. Delgado ED, Schoenecker PL, Rich MM, et al. Treatment of severe torsional malalignment syndrome. J Pediatr Orthop. 1996 Jul-Aug;16(4):484-8. Abstract

49. Lincoln TL, Suen PW. Common rotational variations in children. J Am Acad Orthop Surg. 2003 Sep-Oct;11(5):312-20. Abstract

50. Lee SH, Chung CY, Park MS, et al. Tibial torsion in cerebral palsy: validity and reliability of measurement. Clin Orthop Relat Res. 2009 Aug;467(8):2098-104. Abstract

51. Hazlewood ME, Simmons AN, Johnson WT, et al. The Footprint method to assess transmalleolar axis. Gait Posture. 2007 Apr;25(4):597-603. Abstract

52. Ruwe PA, Gage JR, Ozonoff MB, et al. Clinical determination of femoral anteversion: a comparison with established techniques. J Bone Joint Surg Am. 1992 Jul;74(6):820-30. Abstract

53. Davids JR, Benfanti P, Blackhurst DW, et al. Assessment of femoral anteversion in children with cerebral palsy: accuracy of the trochanteric prominence angle test. J Pediatr Orthop. 2002 Mar-Apr;22(2):173-8. Abstract

54. Chung CY, Lee KM, Park MS, et al. Validity and reliability of measuring femoral anteversion and neck-shaft angle in patients with cerebral palsy. J Bone Joint Surg Am. 2010 May;92(5):1195-205. Abstract

55. Greene WB. Genu varum and genu valgum in children: differential diagnosis and guidelines for evaluation. Compr Ther. 1996 Jan;22(1):22-9. Abstract

56. Perry J, Hoffer MM, Giovan P, et al. Gait analysis of the triceps surae in cerebral palsy: a preoperative and postoperative clinical and electromyographic study. J Bone Joint Surg Am. 1974 Apr;56(3):511-20. Abstract

57. Shtarker H, Volpin G, Stolero J, et al. Correction of combined angular and rotational deformities by the Ilizarov method. Clin Orthop Relat Res. 2002 Sep;(402):184-95. Abstract

58. Jakob RP, Haertel M, Stussi E. Tibial torsion calculated by computerised tomography and compared to other methods of measurement. J Bone Joint Surg Br. 1980 May;62-B(2):238-42. Abstract

59. Paley D, Tetsworth K. Mechanical axis deviation of the lower limbs: preoperative planning of uniapical angular deformities of the tibia or femur. Clin Orthop Relat Res. 1992 Jul;(280):48-64. Abstract

60. Davids JR, Blackhurst DW, Allen BL Jr. Clinical evaluation of bowed legs in children. J Pediatr Orthop B. 2000 Oct;9(4):278-84. Abstract

61. Langenskiöld A. Tibia vara: a critical review. Clin Orthop Relat Res. 1989 Sep;(246):195-207. Abstract

62. Langenskioeld A, Riska EB. Tibia vara (osteochondrosis deformans tibiae): a survey of seventy-one cases. J Bone Joint Surg Am. 1964 Oct;46:1405-20. Abstract

63. Murphy SB, Simon SR, Kijewski PK, et al. Femoral anteversion. J Bone Joint Surg Am. 1987 Oct;69(8):1169-76. Abstract

64. Hudson D, Royer T, Richards J. Ultrasound measurements of torsions in the tibia and femur. J Bone Joint Surg Am. 2006 Jan;88(1):138-43. Abstract

65. Schneider B, Laubenberger J, Jemlich S, et al. Measurement of femoral antetorsion and tibial torsion by magnetic resonance imaging. Br J Radiol. 1997 Jun;70(834):575-9. Abstract

66. Bruce WD, Stevens PM. Surgical correction of miserable malalignment syndrome. J Pediatr Orthop. 2004 Jul-Aug;24(4):392-6. Abstract

67. Stevens PM, Anderson D. Correction of anteversion in skeletally immature patients: percutaneous osteotomy and transtrochanteric intramedullary rod. J Pediatr Orthop. 2008 Apr-May;28(3):277-83. Abstract

68. Basaran SH, Ercin E, Bayrak A, et al. The measurement of tibial torsion by magnetic resonance imaging in children: the comparison of three different methods. Eur J Orthop Surg Traumatol. 2015 Dec;25(8):1327-32. Abstract

69. Muhamad AR, Freitas JM, Bomar JD, et al. CT and MRI lower extremity torsional profile studies: measurement reproducibility. J Child Orthop. 2012 Oct;6(5):391-6.Full text  Abstract

70. Gaumétou E, Quijano S, Ilharreborde B, et al. EOS analysis of lower extremity segmental torsion in children and young adults. Orthop Traumatol Surg Res. 2014 Feb;100(1):147-51. Abstract

71. Meyrignac O, Moreno R, Baunin C, et al. Low-dose biplanar radiography can be used in children and adolescents to accurately assess femoral and tibial torsion and greatly reduce irradiation. Eur Radiol. 2015 Jun;25(6):1752-60. Abstract

72. Szuper K, Schlégl ÁT, Leidecker E, et al. Three-dimensional quantitative analysis of the proximal femur and the pelvis in children and adolescents using an upright biplanar slot-scanning X-ray system. Pediatr Radiol. 2015 Mar;45(3):411-21. Abstract

73. Schoenecker PL, Rich MM. The lower extremity. In: Morrissy RT, Weinstein SL, eds. Lovell and Winter's pediatric orthopaedics. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:1160-1163.

74. Kling TF Jr, Hensinger RN. Angular and torsional deformities of the lower limbs in children. Clin Orthop Relat Res. 1983 Jun;(176):136-47. Abstract

75. Dodgin DA, De Swart RJ, Stefko RM, et al. Distal tibial/fibular derotation osteotomy for correction of tibial torsion: review of technique and results in 63 cases. J Pediatr Orthop. 1998;18:95-101. Abstract

76. Redmond AC. An evaluation of the use of gait plate inlays in the short-term management of the intoeing child. Foot Ankle Int. 1998 Mar;19(3):144-8. Abstract

77. Redmond AC. The effectiveness of gait plates in controlling in-toeing symptoms in young children. J Am Podiatr Med Assoc. 2000 Feb;90(2):70-6. Abstract

78. Uden H, Kumar S. Non-surgical management of a pediatric "intoed" gait pattern - a systematic review of the current best evidence. J Multidiscip Healthc. 2012;5:27-35.Full text  Abstract

79. Staheli LT. Torsion: treatment indications. Clin Orthop Relat Res. 1989 Oct;(247):61-6. Abstract

80. Gage JR, Schwartz M. Pathological gait and lever-arm dysfunction. In: Gage JR, ed. The treatment of gait problems in cerebral palsy. London, UK: Mac Keith Press; 2004:180-204.

81. Pascual-Pascual SI, Pascual-Castroviejo I, Ruiz PJ. Treating spastic equinus foot from cerebral palsy with botulinum toxin type A: what factors influence the results?: an analysis of 189 consecutive cases. Am J Phys Med Rehabil. 2011 Jul;90(7):554-63. Abstract

82. Kay RM, Rethlefsen SA, Fern-Buneo A, et al. Botulinum toxin as an adjunct to serial casting treatment in children with cerebral palsy. J Bone Joint Surg Am. 2004 Nov;86-A(11):2377-84. Abstract

83. King HA, Staheli LT. Torsional problems in cerebral palsy. Foot Ankle. 1984 Jan-Feb;4(4):180-4. Abstract

84. Rethlefsen SA, Kay RM. Transverse plane gait problems in children with cerebral palsy. J Pediatr Orthop. 2013 Jun;33(4):422-30. Abstract

85. Rushforth GF. The natural history of hooked forefoot. J Bone Joint Surg Br. 1978 Nov;60-B(4):530-2. Abstract

86. Farsetti P, Weinstein SL, Ponseti IV. The long-term functional and radiographic outcomes of untreated and non-operatively treated metatarsus adductus. J Bone Joint Surg Am. 1994 Feb;76(2):257-65. Abstract

87. Canadian Paediatric Society. Footwear for children. Feb 2009 [internet publication].Full text

88. Staheli LT. Torsional deformity. Pediatr Clin North Am. 1977;24:799-811. Abstract

89. Fuchs R, Staheli LT. Sprinting and intoeing. J Pediatr Orthop. 1996;16:489-491. Abstract

90. Staheli LT, Engel GM. Tibial torsion: a method of assessment and a survey of normal children. Clin Orthop Relat Res. 1972;86:183-186. Abstract

91. Watanabe RS. Embryology of the human hip. Clin Orthop Relat Res. 1974;(98):8-26. Abstract

92. Walker JM. Comparison of normal and abnormal human fetal hip joints: a quantitative study with significance to congenital hip disease. J Pediatr Orthop. 1983;3:173-183. Abstract

93. Fabry G, MacEwen GD, Shands AR Jr. Torsion of the femur: a follow-up study in normal and abnormal conditions. J Bone Joint Surg Am. 1973;55:1726-1738. Abstract

94. Fabry G, Cheng LX, Molenaers G. Normal and abnormal torsional development in children. Clin Orthop Relat Res. 1994;(302):22-26. Abstract

95. Hubbard DD, Staheli LT, Chew DE, et al. Medial femoral torsion and osteoarthritis. J Pediatr Orthop. 1988;8:540-542. Abstract

96. Tonnis D, Heinecke A. Diminished femoral antetorsion syndrome: a cause of pain and osteoarthritis. J Pediatr Orthop. 1991;11:419-431. Abstract

97. Goutallier D, Van Driessche S, Manicom O, et al. Influence of lower-limb torsion on long-term outcomes of tibial valgus osteotomy for medial compartment knee osteoarthritis. J Bone Joint Surg Am. 2006;88:2439-2447. Abstract

98. Akcali O, Tiner M, Ozaksoy D. Effects of lower extremity rotation on prognosis of flexible flatfoot in children. Foot Ankle Int. 2000;21:772-774. Abstract

99. Inman VT. Hallux valgus: a review of etiologic factors. Orthop Clin North Am. 1974;5:59-66. Abstract

100. Bramer JA, Maas M, Dallinga RJ, et al. Increased external tibial torsion and osteochondritis dissecans of the knee. Clin Orthop Relat Res. 2004;(422):175-179. Abstract

101. Edeen J, Dainer RD, Barrack RL, et al. Results of conservative treatment of recalcitrant anterior knee pain in active young adults. Orthop Rev. 1992;21:593-599. Abstract

102. Beals RK. Developmental changes in the femur and acetabulum in spastic paraplegia and diplegia. Dev Med Child Neurol. 1969;11:303-313. Abstract

103. Lewis FR, Samilson RR, Lucas DB. Femoral torsion and coax valga in cerebral palsy: a preliminary report. Dev Med Child Neurol. 1964;6:591-597. Abstract

104. Bobroff ED, Chambers HG, Sartoris DJ, et al. Femoral anteversion and neck-shaft angle in children with cerebral palsy. Clin Orthop Relat Res. 1999;(364):194-204. Abstract

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