Eva Ciccodicola, Oussama Abousamra, Veronica Beltran, Susan A Rethlefsen, Tishya A L Wren
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The association of TMA and external tibial torsion to demographic and clinical examination data were examined.</p><p><strong>Results: </strong>Two hundred forty-seven patients were included with 422 valgus feet (175 bilateral). External tibial torsion was observed in 11.6% of limbs. Tibial torsion became more external with age (β = 0.12, 95% CI = [0.02, 0.22], <i>P</i> = .02). TMA was correlated with dorsiflexion (β = -0.10, 95% CI = [-0.18, -0.02], <i>P</i> = .02) and hindfoot inversion range of motion (ROM) (β = 0.19, 95% CI = [0.06, 0.31], <i>P</i> = .005). Tibial torsion was not correlated with gender, Gross Motor Function Classification System (GMFCS) level, plantarflexor spasticity, or knee extension ROM.</p><p><strong>Conclusions: </strong>External tibial torsion as a possible contributor to transverse plane malalignment needs to be considered in older patients with CP who have pes valgus with limited hindfoot inversion ROM. Our results highlight that external tibial torsion increases with age, increased dorsiflexion, and limited hindfoot inversion ROM. Overlooking external tibial torsion when correcting pes valgus could result in under correction of malalignment and continued functional limitations related to lever arm dysfunction.</p><p><strong>Key concepts: </strong>(1)The causes of external foot progression are often multifactorial, including both external tibial torsion and pes valgus.(2)External tibial torsion needs to be considered as a possible contributor to transverse plane malalignment in older patients with CP with pes valgus and limited hindfoot inversion ROM.(3)Failure to recognize external tibial torsion may lead to undercorrection of lever arm dysfunction for patients with CP.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"10 ","pages":"100151"},"PeriodicalIF":0.0000,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088111/pdf/","citationCount":"0","resultStr":"{\"title\":\"Clinical Measures Associated With Tibial Torsion in Ambulatory Children With Cerebral Palsy and Pes Valgus.\",\"authors\":\"Eva Ciccodicola, Oussama Abousamra, Veronica Beltran, Susan A Rethlefsen, Tishya A L Wren\",\"doi\":\"10.1016/j.jposna.2024.100151\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Transverse plane alignment deviations in individuals with cerebral palsy (CP) contribute to lever arm dysfunction. The cause of this is often multifactorial. External tibial torsion and pes valgus are both possible causes. Tibial torsion could be missed without detailed clinical exam. The purpose of this study was to examine factors associated with external tibial torsion in patients with CP and pes valgus.</p><p><strong>Methods: </strong>We retrospectively examined patients with CP who had pes valgus. Participants underwent clinical examination, including transmalleolar axis angle (TMA). TMA >20° external was considered clinically significant external tibial torsion. The association of TMA and external tibial torsion to demographic and clinical examination data were examined.</p><p><strong>Results: </strong>Two hundred forty-seven patients were included with 422 valgus feet (175 bilateral). External tibial torsion was observed in 11.6% of limbs. Tibial torsion became more external with age (β = 0.12, 95% CI = [0.02, 0.22], <i>P</i> = .02). TMA was correlated with dorsiflexion (β = -0.10, 95% CI = [-0.18, -0.02], <i>P</i> = .02) and hindfoot inversion range of motion (ROM) (β = 0.19, 95% CI = [0.06, 0.31], <i>P</i> = .005). Tibial torsion was not correlated with gender, Gross Motor Function Classification System (GMFCS) level, plantarflexor spasticity, or knee extension ROM.</p><p><strong>Conclusions: </strong>External tibial torsion as a possible contributor to transverse plane malalignment needs to be considered in older patients with CP who have pes valgus with limited hindfoot inversion ROM. Our results highlight that external tibial torsion increases with age, increased dorsiflexion, and limited hindfoot inversion ROM. 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引用次数: 0
摘要
背景：脑瘫（CP）患者的横切面对准偏差导致杠杆臂功能障碍。造成这种情况的原因往往是多方面的。胫骨外扭转和外翻都是可能的原因。如果没有详细的临床检查，可能会遗漏胫骨扭转。本研究的目的是研究与CP和外翻患者胫骨外扭转相关的因素。方法：回顾性分析伴有外翻的CP患者。参与者接受临床检查，包括踝外轴角（TMA）。TMA bbb20°外旋被认为是临床上明显的胫骨外扭转。研究了TMA和胫骨外扭转与人口统计学和临床检查数据的关系。结果：纳入患者247例，外翻足422例（双侧175例）。11.6%的肢体出现胫骨外扭转。胫骨扭转随年龄增长变得更加外部(β= 0.12,95% CI = [0.02, 0.22], P = .02点)。TMA是与背屈(β= -0.10,95% CI = [-0.18, -0.02], P = .02点)和hindfoot反演活动度(ROM)(β= 0.19,95% CI = [0.06, 0.31], P = .005)。胫骨扭转与性别、大运动功能分类系统（GMFCS）水平、跖屈肌痉挛或膝关节伸展rom无关。对于患有外翻并后足内翻ROM有限的老年CP患者，需要考虑胫骨外扭转作为横向平面失调的可能因素。我们的研究结果强调，胫骨外扭转随着年龄的增长而增加，在矫正外翻时忽视胫骨外扭转可能导致矫正错位和持续的与杠杆臂功能障碍相关的功能限制。关键概念：(1)外足进展的原因通常是多因素的，包括胫骨外扭转和外翻(2)胫骨外扭转可能是老年CP合并外翻和后足内翻ROM受限的患者横平面失调的一个因素。(3)未能识别胫骨外扭转可能导致CP患者杠杆臂功能障碍矫正不足。
Clinical Measures Associated With Tibial Torsion in Ambulatory Children With Cerebral Palsy and Pes Valgus.
Background: Transverse plane alignment deviations in individuals with cerebral palsy (CP) contribute to lever arm dysfunction. The cause of this is often multifactorial. External tibial torsion and pes valgus are both possible causes. Tibial torsion could be missed without detailed clinical exam. The purpose of this study was to examine factors associated with external tibial torsion in patients with CP and pes valgus.
Methods: We retrospectively examined patients with CP who had pes valgus. Participants underwent clinical examination, including transmalleolar axis angle (TMA). TMA >20° external was considered clinically significant external tibial torsion. The association of TMA and external tibial torsion to demographic and clinical examination data were examined.
Results: Two hundred forty-seven patients were included with 422 valgus feet (175 bilateral). External tibial torsion was observed in 11.6% of limbs. Tibial torsion became more external with age (β = 0.12, 95% CI = [0.02, 0.22], P = .02). TMA was correlated with dorsiflexion (β = -0.10, 95% CI = [-0.18, -0.02], P = .02) and hindfoot inversion range of motion (ROM) (β = 0.19, 95% CI = [0.06, 0.31], P = .005). Tibial torsion was not correlated with gender, Gross Motor Function Classification System (GMFCS) level, plantarflexor spasticity, or knee extension ROM.
Conclusions: External tibial torsion as a possible contributor to transverse plane malalignment needs to be considered in older patients with CP who have pes valgus with limited hindfoot inversion ROM. Our results highlight that external tibial torsion increases with age, increased dorsiflexion, and limited hindfoot inversion ROM. Overlooking external tibial torsion when correcting pes valgus could result in under correction of malalignment and continued functional limitations related to lever arm dysfunction.
Key concepts: (1)The causes of external foot progression are often multifactorial, including both external tibial torsion and pes valgus.(2)External tibial torsion needs to be considered as a possible contributor to transverse plane malalignment in older patients with CP with pes valgus and limited hindfoot inversion ROM.(3)Failure to recognize external tibial torsion may lead to undercorrection of lever arm dysfunction for patients with CP.
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