Ann Rehabil Med.  2017 Jun;41(3):441-449. 10.5535/arm.2017.41.3.441.

A New Instrument for Measuring Tibial Torsion in Pediatric Patients

• Jeon JH
• Yoon YS
• Lee KJ
• Yu KP
• Lee JH
• Seog TY
• Son E

• KMID: 2389460
• DOI: http://doi.org/10.5535/arm.2017.41.3.441

Abstract

OBJECTIVE
To develop and test the validity and reliability of a new instrument for measuring the thigh-foot angle (TFA) for the patients with in-toeing and out-toeing gait.
METHODS
The new instrument (Thigh-Foot Supporter [TFS]) was developed by measuring the TFA during regular examination of the tibial torsional status. The study included 40 children who presented with in-toeing and out-toeing gaits. We took a picture of each case to measure photographic-TFA (P-TFA) in the proper position and to establish a criterion. Study participants were examined by three independent physicians (A, B, and C) who had one, three and ten years of experience in the field, respectively. Each examiner conducted a separate classical physical examination (CPE) of every participant using a gait goniometer followed by a TFA assessment of each pediatric patient with or without the TFS. Thirty minutes later, repeated in the same way was measured.
RESULTS
Less experienced examiner A showed significant differences between the TFA values depending on whether TFS used (left p=0.003 and right p=0.008). However, experienced examiners B and C did not show significant differences. Using TFS, less experienced examiner A showed a high validity and all examiner's inter-test and the inter-personal reliabilities increased.
CONCLUSION
TFS may increase validity and reliability in measuring tibial torsion in patients who has a rotational problem in lower extremities. It would be more useful in less experienced examiners.

Keyword

Bone anteversion; Metatarsus varus; Torsion abnormality; Tibial torsion

MeSH Terms

Bone Anteversion
Child
Gait
Humans
Lower Extremity
Physical Examination
Reproducibility of Results
Torsion Abnormality

Figure

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  Fig. 1 Thigh-Foot Supporter.

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  Fig. 2 Standard universal goniometer.

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  Fig. 3 Flow chart of clinical measurement. P-TFA, photographic-thigh-foot angle; CPE, classical physical examination; TFS, Thigh-Foot Supporter.

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  Fig. 4 Measurement of photographic thigh-foot angle (P-TFA) and thigh-foot angle (TFA) using Thigh-Foot Supporter (TFS). Lying in the prone position keeping knee joint at 90°, the ankle joint in neutral, the sole of the foot in the parallel to the floor. Then we took photos to show both thighs and feet (A). TFA was measured fixing the tibia at 90° in the sagittal and transverse plane with moving the wing of TFS (B, C).

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  Fig. 5 Inter-test reliability of examiner A and inter-personal reliability. Inter-test reliability: (A) TFA by CPE of examiner A and (B) TFA by TFS of examiner A. Inter-personal reliability: (C) TFA by CPE and (D) TFA by TFS. TFA, thigh-foot angle; CPE, classical physical examination; TFS, Thigh-Foot Supporter.

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