IS THERE A RELATIONSHIP BETWEEN CHILDREN’S POSTURAL HABITS AND TORSIONAL DEFECTS OF THE LOWER LIMBS ?

Abstract

Purpose: Parent worry about torsional or angular anomalies of the lower limbs of their children is widespread. The relationship between a child’s postural habits and torsional anomalies of the lower limbs is often mentioned in the literature despite the lack of a single study demonstrating solid evidence. Active treatment of such anomalies is exceptionally necessary. Postural education is undoubtedly provided by parents. The purpose of this study was not to establish a cause and effect relationship between postural habits and torsional anomalies but rather to determine whether children who exhibit a preferential nocturnal and diurnal posture have torsional anomalies of the lower limbs.

Material and methods: This retrospective analysis included all patients consulting one paediatric orthopaedist for in-toeing during a period of six years. Patients with a neurological disorder, bone and joint disease, or a congenital malformation as well as those with a history of orthesis use for fracture or surgery of the lower limbs were excluded. The cohort was composed of 463 children aged 1.5 to 15 years. Five habitual postures were studied: sitting cross-legged, sitting on knees feet under the buttocks, laying on knees with buttocks upward and feet inward, laying on belly knees extended and feet inward, and indifferent sitting and reclining positions. Abnormal torsion was determined clinically. Internal hip rotation greater than 70 (Staheli) observed in the ventral decubitus position with knees flexed 90° was considered to indicate excessive femoral anteversion (EFAV). Internal tibial torsion (ITT) was considered to be present when the thigh-foot angle was 0 measured in the ventral decubitus position or sitting on the table legs hanging. We searched for correlations between habitual posture and abnormal torsion as well as the influence of gender and age using the chi-square test and 95% confidence intervals. Patients with both EFAV and ITT were stratified by group using the Woolf method associated with the Mantel-Haenszel test.

Results: Abnormal torsion was found more often in children aged less than 4 years with no difference between boys and girls. Among the children in this study presenting in-toeing, 31% did not have a preferred sitting or reclining position and only 7% presented clearly abnormal torsion. There was a significant direct correlation between EFAV and sitting crosslegged and a significant inverse correlation between EFAV and the other habitual postures. Conversely, there was no significant correlation between ITT and the habitual postures studied.

Discussion and conclusion: This study provided objective information concerning widely accepted but poorly documented notions. There were two limitations: 1) the lack of a control group not presenting in-toeing, 2) the absence of precise goniometric measurements, a problem encountered in most studies using clinical methods. Although the presence of abnormal torsion of the lower limb appears to significantly influence the gait pattern in children, it does not appear to affect habitual postures. A significant relationship was found only between habitual posture and EFAV, and not ITT. These results should be taken into consideration when planning treatment.