Hello
And welcome everyone
to our youtube program students in physiotherapy.
Today, new topic
and we will talk about
the musculoskeletal misalignments of the lower limbs
that can affect children.
We start with femoral anteversion.
This is a condition
where the femoral neck leans forward,
causing an internal rotation of the entire tip.
The causes can be multiple
such as a decrease in intrauterine space
an abnormal position of the fetus
muscle imbalance
or the presence of a condition called oligohydramnios.
It's a deficient volume of amniotic fluid
Epidemiologically, it affects girls more often than boys.
We continue
with the knee varum and the knee valgum.
The varum knee
is a deviation of the leg towards the outside
i.e. the knees deflect towards the outside.
It is physiological between 0 and 2 years old.
Therefore, a pathologic varum
may be caused by rickets or Blount's disease.
A valgum knee is almost the opposite,
the legs are deflected inward
the knees are inward.
It is physiological after the age of 2 years old.
A pathologic valgum may be caused by
rickets,
kidney failure,
certain diseases such as Marfan syndrome,
the presence of a neurologic condition such as polio,
or the presence of a trauma such as a fracture.
In both cases,
no epidemiological data were found
because they are considered benign orthopedic conditions.
We continue
with internal tibial torsion.
It's a deviation into the tibial bone.
It can be caused by
a poor intrauterine position
or the presence of femoral anteversion.
Epidemiologically,
it affects both boys and girls.
We finish with the adductus metatarsus
is a deformation of the metatarsal
characterized by a deformation
of the foot inwards.
It corresponds to the association of two deviations
which are the adduction and supination
of the forefoot relative to the hindfoot.
It can be caused by
the presence of oligohydramnios
or a poor intrauterine position.
Regarding epidemiology,
about 1/400 children are born with an adductus metatarsus.
We continue with Amanda
to talk about the signs and symptoms
We start with Ricardo,
Leonard's father,
who has the following question:
My son sits in a W,
and he sleeps upside down with the magpies inside.
Do I have to worry?
Ricardo, according to the description,
it appears to be a sign of femoral anteversion.
Compared to the prognosis,
there's nothing to worry about.
This is a normal variation in the child's development.
In most cases,
it will return to a normal position
without treatment being necessary.
However, in adulthood,
this could cause coxarthrosis.
Second question.
Araceli, Nina's mother, 1 year old
When Nina is standing or walking,
her knees separate and her ankles come closer.
That's normal ?
Araceli,
at this moment, there's nothing to worry about.
It's normal development,
it's a varum knee.
Now, there is no problem,
but if it gets worse or if it persists
after her two years,
you will have to consult.
With respect to prognosis,
as you can see on the article on the screen,
one of the consequences of a varum knee
is arthritis
in the medial compartment of the knee.
Next question from Jonathan.
My son has a very curved right foot.
like the shape of a banana
He is 4 years old
Do we have to worry ?
Jonathan,
according to the description,
we can think of a metartarsus adductus.
As you can see from the article on the screen,
metartarsus adductus causes
an increase in plantar pressure on the lateral edges of the feet.
If I were you,
I'd go to the doctor,
even though it disappears as an adult.
The last question.
Manual, Tiago's mother, 17 months old
He started walking two months ago,
but it looks like his legs are turning in.
He walks with his feet inwards.
Is it something abnormal?
Manuela,
Tiago is still little,
according to what you said,
it would seem that it is an internal tibial torsion.
According to evolution
it is a physiological phenomenon
that corrects itself
spontaneously
before the age of 5 years.
I'd watch him, but I wouldn't worry.
For malformations in children,
There are not a lot of surgical indications
As you can see in the article,
it is only indicated if there are very serious deformities
and if the child is over 8 years old.
For femoral anteversion,
surgical treatment is indicated
if it causes functional or aesthetic problems
at the end of childhood
because spontaneous correction is no longer possible.
Orthopaedic treatment includes
a desrotation femoral splint,
paying attention to anterior iatrogenic hip dislocation
which may be caused by external rotational correction.
You can also use soles that improve internal rotation,
as indicated by the article on the screen.
For varum and valgum knees,
if they are physiological,
they do not require treatment
because they have no associated complications.
In case of rickets, in both cases,
vitamin D treatment is necessary.
In case of varum knee, due to Blount's disease,
treatment is essential,
orthopedic or, in severe cases, surgery.
In the case of a knee valgum caused by trauma,
no action is necessary.
Internal tibial torsion
is spontaneously corrected before the age of 5.
Orthopaedic treatment includes
the use of splints that can be beneficial.
Femoro-tibial if the disorder is unilateral
or Denis-Browne's if it is a bilateral disorder.
The correction of adductus metatarsus
is done with boots or plasters (between 0 and 6 years).
They are effective when they start early
(from the first month after birth)
as indicated in the article on the screen.
Orthopaedic treatment includes
strapping, rigid splints or insoles.
However, if conservative treatment fails,
surgery is indicated.
Hello, everyone, we are in Cristina's clinic.
Hello Cristina.
Hello Esteban.
You're physiotherapist in Valencia.
We will talk about the misalignments of the lower limb and its treatment.
Exactly
Can you tell us about femoral anteversion treatment?
Of course.
Compared to femoral anteversion,
what is very important is to give advice, recommendations,
so that femoral anteversion does not evolve negatively,
so that it is a normal development in children.
In consultation,
we can start by working on active mobilizations,
external rotations of the hip,
for example by working the gluteus etc
Also, at night,
we can use a night splint to promote this position.
But what we must pay attention to is the anterior dislocation of the hip.
The physiotherapist, for femoral anteversion,
will have a particular role in prevention
to avoid bad positions
and all those that prevent proper hip alignment.
For example,
when a child does not have a good posture when sitting,
what is colloquially called "sitting in a W",
teach him to sit in the Indian position for example.
They are little things that come to help that.
And compared to varum knee or valgum knee,
what can you tell us about the treatment?
So, for varum knee and valgum knee,
despite any panel of techniques we have,
neither claims to correct these two cases,
only surgery with current knowledge can be proposed.
In both cases, if surgery is indicated,
a rehabilitation treatment consist of
progressive knee mobilization,
thermotherapy to relieve pain
and strengthening exercises for
the quadriceps, hamstrings and buttocks.
For morphological disorders such as varum or valgum knee,
it seems that Postural Reconstruction
is beneficial for all the pain caused by this anomaly.
But, we lack studies for it,
as the article that appears on the screen says.
And, what about another misalignment
like internal tibial torsion?
So for internal tibial torsion,
no specific treatment was found.
What must be done is to monitor all positions
that prevent spontaneous correction
or those that exacerbate the problem.
Okay, well, and the last one
metatarsus adductus, what can you tell us?
For the metatarsus adductus,
the objectives consist in
a stretching of musculature,
the soft parts that are contracted.
And in fact by being contracted,
they bring the foot inwards.
After that,
decoaptation, abduction and pronation mobilizations
are also included.
Especially in children,
what it's very important
is the stimulation of reflexes and sensory afferences.
For example, with a toothbrush
we will stimulate the outer edge of the foot
and move up towards the musculature.
Okay, to conclude on
the musculoskeletal misalignments of the lower limbs
and as you can see in the article on the screen,
many alterations resolve spontaneously over time.
However, if it exist a deformity,
with medical supervision,
it usually does not cause major problems.
Thank you all very much,
we hope you enjoyed the video!
See you soon !
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