Ann Rehabil Med.  2014 Apr;38(2):218-225.

The Therapeutic Effect of Tibia Counter Rotator With Toe-Out Gait Plate in the Treatment of Tibial Internal Torsion in Children

• Son SM
• Ahn SH
• Jung GS
• Seo SW
• Park IS
• Song JC
• Jang SH
• Do KH

Abstract

OBJECTIVE
To evaluate the therapeutic effect of a Tibia Counter Rotator (TCR) with toe-out gait plate (GP) upon tibial internal torsion by a comparative analysis of transmalleolar angle (TMA) and gait analysis with GP alone.
METHODS
Twenty participants with tibial internal torsion were recruited for this study. Each 10 participants were included in group A with TCR and GP application and in group B with GP application only. The TMA and the kinematic results were used for the evaluation of the therapeutic effects of orthoses.
RESULTS
Within each group, TMA showed a significant increase after treatment. Group A showed a continuous improvement up to six months, however, group B showed an improvement up to five months only. Group A showed a significantly higher correction effect than group B after treatment. Regarding kinematic data, both groups showed a significantly decreased mean ankle adduction angle after treatment. However, group A showed a significantly lower mean ankle adduction angle than group B after six months.
CONCLUSION
The group with TCR and GP showed a significantly better outcome and continued correction force compared to the group with GP only. Our results suggest that TCR with GP may be useful therapeutic orthoses for children with tibial internal torsion.

Keyword

Tibia; Torsion; Foot orthoses; Gait

MeSH Terms

Ankle
Child*
Foot Orthoses
Gait*
Humans
Orthotic Devices
Tibia*

Figure

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  Fig. 1 Flowchart of subject selection. Fifty-one participants diagnosed as tibial internal torsion. Of 51 participants were 16 participants excluded who did not meet the age criterion: 12 participants were diagnosed as developmental delay and 3 participants had traumatic events on lower extremities during the study period. Finally, 20 participants were included in the study. A clinical coordinator unaware of the clinical data of participants randomized the subjects into two groups. Among 20 participants, 10 participants were included into group A with Tibial Counter Rotator (TCR) and toe-out gait plate (GP). The remaining 10 participants were included into group B with GP application only.

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  Fig. 2 Tibial Counter Rotator (TCR). (A) Anterior view, (B) oblique view, and (C) inferior view. TCR consisted of well-padded straps (Velcro), foot plate and metal brace (A, B). The initial setting angle was the end point of leg lateral motion with a flexed knee position. Foot plate angle was increased using units of 5° as the patients visited the foot clinic monthly (C). All participants were instructed to apply TCR with a flexed knee position during sleep for at least 3 hours a day.

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  Fig. 3 Measurement of transmalleolar angle (TMA). TMA was measured using a gravity goniometer in the supine position after marking the medial malleolus of the tibia and lateral malleolus of the fibula while extending the knee to the coronal plane [5,6,8,9,18]. The negative value refers to the internal rotation of the tibia, whereas the positive value refers to the external rotation.

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  Fig. 4 Comparative results of transmalleolar angle within both groups. TCR, Tibial Counter Rotator; GP, toe-out gait plate. *p<0.05.

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  Fig. 5 Comparative results of mean foot ankle adduction angle in both groups. TCR, Tibial Counter Rotator; GP, toe-out gait plate. *p<0.05.

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