tibia torsion in child
Paula Martinek
Description
Collection
Title:
tibia torsion in child
Creator:
Paula Martinek
Date:
10/14/2008
Text:
Dear All: This is the list of responses on my question about how to handle tibia torsion for a five year old. I am starting with AFOs to address the valgus, with a very high trimline on the lateral border of the foot and wrapped around lateral aspect of the leg, to help with the derotation.I am also looking into the derotation straps made by SureFit Inc. I think this child is too old for any nighttime brace and that she needs something for daytime use. I'll let you know how it turns out. Paula Martinek, LPO
Our approach would be to custom fabricate a Wheaton Style KAFO, it may be more costly so you will need to speak with your patients parents.
Hi.I think twister cables combined with AFOs would be more effective and you can control his ankle's pes valgus with AFOs.But to my knowledge and experience twister cables are used throughout day.Besides that, usually the twister cables are not corrective devices and they are just effective while the child walks with them(supportive), especially in this case that has rett's syndrome.
PAULA---TAKE A LATERAL TRACING OF THE LEG WITH KNEE AND ANKLE AT 90 DEGREES----YOU CAN USE A PREFAB SOLID ANLKE OR MAKE A CUSTOM ONE-----ADD A PRE DRILLED AND TAPPED VAC FORM UPRIGHT TO POSTERIOR ASPECT OF AFO --OR IF USING A PRE FAB AFO JUST ADD THE METAL BAR ADJUSTABLE SEGMENT TO THE AFO WITH A COUPLE OF COOPER RIVETS......NOW ADD A 90 DEGREE BENT 5/8 X1/4 INCH POSTERIOR UPRIGHT THAT WILL ATTACH TO A 2 INCH POSTERIOR THIGH BAND AND LEATHER CUFF TO HOLD THE KNEE AT 90 DEGREES------THE POSTERIOR KAFO UPRIGHT CAN BE TWISTED TO PLACE THE AFO IN THE AMOUNT OF EXTERNAL ROTATION YOU DESIRE....YOU CAN ALSO PLACE A LARGE DENNIS BROWN FOOT PLATE ON THE BOTTOM OF THE AFO AND ATTACH THE SERATED COMPONENT TO THS BOTTOM OF THE POSTERIOR UPRIGHT THAT HAS BEE PREBENT AT 90 DEGREES SO YOU CAN ROTATE THR FOOT COMPLEX WHERE YOU WANT ---IF YOU SEND ME YOUR ADDRESS ILL FAX YOU A DRAWING..WE HAVE MADE ABOUT 300 OF THESE OVER THE PAST 20 YEARS GOOD LUCK
You would protect the patient's knees if you introduced the cables and attached them to KAFOs (free knee)If you attach them to AFO's you will create a lot of unwanted torque at the knee and at 5 years old that could cause excessive rotational forces to the ligaments of the knee joint causing unwanted rotational ROM. It does not really matter none of those devices correct Tibia Torsion the only answer is surgery if problem is bad enough. Tibia and Fibula float around a imaginary joint and you can not apply rotation force to the long bone. in fact about the only thing these braces do is apply torque to the knee joints which is not good.
Try contacting the www.ultraflexsystems.com to see if their designs willwork. We have used them with pretty good success. Twisters won't work for night use. Any knee flexion, which would beinevitable in a recumbent position, would defeat the torsion effect ofthe cables. Try a custom kafo similar to a wheaton or a solid one pieceposterior shell in the desired position. Good luck
Just a few months ago, I posed a question to the list regarding the effectiveness of wheaton style kafo's, as related to age.The major thing I learned, is that with tibial torsion, we get the best results before the age of 4.I would competely agree, though, that night time devices that are similar to the Wheatons would be excellent.I would be very cautious though, about putting twister cables on, just due to the torsion created at the knee and hip.Hope this helps.
My other idea is bil KAFOs for night with locked joints at 90 flexion, so they mimick with the wheaton does. My question is how effective and can the twisters be worn at night? ZERO effective at night in my opinion Any other ideas for torsion braces? Does he have any hip joint involvement ? Maybe he should be in a Hkafo to maintain proper hip position as well as rotational control, but I’m not sure I see the need for locked knees. Thank you in advance.
Our approach would be to custom fabricate a Wheaton Style KAFO, it may be more costly so you will need to speak with your patients parents.
Hi.I think twister cables combined with AFOs would be more effective and you can control his ankle's pes valgus with AFOs.But to my knowledge and experience twister cables are used throughout day.Besides that, usually the twister cables are not corrective devices and they are just effective while the child walks with them(supportive), especially in this case that has rett's syndrome.
PAULA---TAKE A LATERAL TRACING OF THE LEG WITH KNEE AND ANKLE AT 90 DEGREES----YOU CAN USE A PREFAB SOLID ANLKE OR MAKE A CUSTOM ONE-----ADD A PRE DRILLED AND TAPPED VAC FORM UPRIGHT TO POSTERIOR ASPECT OF AFO --OR IF USING A PRE FAB AFO JUST ADD THE METAL BAR ADJUSTABLE SEGMENT TO THE AFO WITH A COUPLE OF COOPER RIVETS......NOW ADD A 90 DEGREE BENT 5/8 X1/4 INCH POSTERIOR UPRIGHT THAT WILL ATTACH TO A 2 INCH POSTERIOR THIGH BAND AND LEATHER CUFF TO HOLD THE KNEE AT 90 DEGREES------THE POSTERIOR KAFO UPRIGHT CAN BE TWISTED TO PLACE THE AFO IN THE AMOUNT OF EXTERNAL ROTATION YOU DESIRE....YOU CAN ALSO PLACE A LARGE DENNIS BROWN FOOT PLATE ON THE BOTTOM OF THE AFO AND ATTACH THE SERATED COMPONENT TO THS BOTTOM OF THE POSTERIOR UPRIGHT THAT HAS BEE PREBENT AT 90 DEGREES SO YOU CAN ROTATE THR FOOT COMPLEX WHERE YOU WANT ---IF YOU SEND ME YOUR ADDRESS ILL FAX YOU A DRAWING..WE HAVE MADE ABOUT 300 OF THESE OVER THE PAST 20 YEARS GOOD LUCK
You would protect the patient's knees if you introduced the cables and attached them to KAFOs (free knee)If you attach them to AFO's you will create a lot of unwanted torque at the knee and at 5 years old that could cause excessive rotational forces to the ligaments of the knee joint causing unwanted rotational ROM. It does not really matter none of those devices correct Tibia Torsion the only answer is surgery if problem is bad enough. Tibia and Fibula float around a imaginary joint and you can not apply rotation force to the long bone. in fact about the only thing these braces do is apply torque to the knee joints which is not good.
Try contacting the www.ultraflexsystems.com to see if their designs willwork. We have used them with pretty good success. Twisters won't work for night use. Any knee flexion, which would beinevitable in a recumbent position, would defeat the torsion effect ofthe cables. Try a custom kafo similar to a wheaton or a solid one pieceposterior shell in the desired position. Good luck
Just a few months ago, I posed a question to the list regarding the effectiveness of wheaton style kafo's, as related to age.The major thing I learned, is that with tibial torsion, we get the best results before the age of 4.I would competely agree, though, that night time devices that are similar to the Wheatons would be excellent.I would be very cautious though, about putting twister cables on, just due to the torsion created at the knee and hip.Hope this helps.
My other idea is bil KAFOs for night with locked joints at 90 flexion, so they mimick with the wheaton does. My question is how effective and can the twisters be worn at night? ZERO effective at night in my opinion Any other ideas for torsion braces? Does he have any hip joint involvement ? Maybe he should be in a Hkafo to maintain proper hip position as well as rotational control, but I’m not sure I see the need for locked knees. Thank you in advance.
Citation
Paula Martinek, “tibia torsion in child,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/229697.
