Ann Rehabil Med.  2018 Feb;42(1):137-144. 10.5535/arm.2018.42.1.137.

Change of Femoral Anteversion Angle in Children With Intoeing Gait Measured by Three-Dimensional Computed Tomography Reconstruction: One-Year Follow-Up Study

• Kong M
• Jo H
• Lee CH
• Chun SW
• Yoon C
• Shin H

• KMID: 2440979
• DOI: http://doi.org/10.5535/arm.2018.42.1.137

Abstract

OBJECTIVE
To evaluate femoral anteversion angle (FAA) change in children with intoeing gait depending on age, gender, and initial FAA using three-dimensional computed tomography (3D-CT).
METHODS
The 3D-CT data acquired between 2006 and 2016 were retrospectively reviewed. Children 4 to 10 years of age with symptomatic intoeing gait with follow-up interval of at least 1 year without active treatment were enrolled. Subjects were divided into three groups based on age: group 1 (≥4 and <6 years), group 2 (≥6 and <8 years), and group 3 (≥8 and <10 years). Initial and follow-up FAAs were measured using 3D-CT. Mean changes in FAAs were calculated and compared.
RESULTS
A total of 200 lower limbs of 100 children (48 males and 52 females, mean age of 6.1±1.6 years) were included. The mean follow-up period was 18.0±5.4 months. Average initial and follow-up FAA in children with intoeing gait was 31.1°±7.8° and 28.9°±8.2°, respectively. The initial FAA of group 1 was largest (33.5°±7.7°). Follow-up FAA of group 1 was significantly reduced to 28.7°±9.2° (p=0.000). FAA changes in groups 1, 2, and 3 were −6.5°±5.8°, −6.4°±5.1°, and −5.3°±4.0°, respectively. These changes of FAA were not significantly (p=0.355) different among the three age groups. However, FAA changes were higher (p=0.012) in females than those in males. In addition, FAA changes showed difference depending on initial FAA. When initial FAA was smaller than 30°, mean FAA change was −5.6°±4.9°. When initial FAA was more than 30°, mean FAA change was −6.8°±5.4° (p=0.019).
CONCLUSION
FAA initial in children with intoeing gait was the greatest in age group 1 (4-6 years). This group also showed significant FAA decrease at follow-up. FAA changes were greater when the child was a female, younger, and had greater initial FAA.

Keyword

Three-dimensional imaging; Bone anteversion; In-toeing gait

MeSH Terms

Bone Anteversion
Child*
Female
Follow-Up Studies*
Gait*
Humans
Imaging, Three-Dimensional
Lower Extremity
Male
Retrospective Studies

Figure

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  Fig. 1 Reference axes of femoral anteversion angle measurement are femoral neck axis (A) and axis between medial and lateral condyles (B).

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  Fig. 2 Femoral anteversion angle measures the angle between long axis of femur neck (A) and transcondylar axis of the distal femur (B) from 3-dimensional computed tomography reconstruction image.

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  Fig. 3 Correlation between the age and change of femoral anteversion angle (FAA) at 3-dimensional computed tomography reconstruction measurement shows that more FAA change in younger children (r=0.083, p=0.243).

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  Fig. 4 Correlation between the initial femoral anteversion angle (FAA) and change of FAA at 3-dimensional computed tomography reconstruction measurement shows more FAA change with greater initial FAA (r=−0.096, p=0.018).

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