Practical Examination - In-toeing and Out-toeing
After proper exposure from umbilicus to toes with an inner wear
Check height and weight which might clue bony displasia or metabolic diseases
Gait - see foot progression angle (Angle between foot print and line of walking )
normal angle is -5 to +20 degrees
-5 to -10 mild , -10 to - 15 moderate
> -15 degrees severe
Look - Leg length discrepancy , any noticeable deformities or muscles wasting
Check Trendelenburg test during standing position
Feel - any tenderness on soft tissue or bony tenderness
Movement
Special test on prone position with a pillow on chest
Hip rotation
Knee in 90 degree flexion , check Hip IR and ER
Normally Hip IR < 70 degrees , ER < 30 degrees
meausre Anteversion angle
Birth ; 40 degrees
9 years ; 20 degrees
16 years ; 16 degrees
Thigh foot angle
normally ; 0-20 degrees
measure tibial and hind foot rotational status
Transmalleolar thigh angle
measures tibial torsion only
normally 0 -40 degrees .
suspect any pathology when there is
pain , limp , LLD , asymmetry , rapid changes in rotational profile.
Check height and weight which might clue bony displasia or metabolic diseases
Gait - see foot progression angle (Angle between foot print and line of walking )
normal angle is -5 to +20 degrees
-5 to -10 mild , -10 to - 15 moderate
> -15 degrees severe
Look - Leg length discrepancy , any noticeable deformities or muscles wasting
Check Trendelenburg test during standing position
Feel - any tenderness on soft tissue or bony tenderness
Movement
Special test on prone position with a pillow on chest
Hip rotation
Knee in 90 degree flexion , check Hip IR and ER
Normally Hip IR < 70 degrees , ER < 30 degrees
meausre Anteversion angle
Birth ; 40 degrees
9 years ; 20 degrees
16 years ; 16 degrees
Thigh foot angle
normally ; 0-20 degrees
measure tibial and hind foot rotational status
Transmalleolar thigh angle
measures tibial torsion only
normally 0 -40 degrees .
suspect any pathology when there is
pain , limp , LLD , asymmetry , rapid changes in rotational profile.
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