The purpose of the study was to document the outcome in adulthood of treatment for idiopathic toe walking.

Twenty of 23 adults who had been previously treated for idiopathic toe walking from 1984 to 1990 were contacted. Three of the 20 subjects lived outside Auckland and four subjects declined to participate, giving a total of 13 subjects suitable for study. All but one of the subjects had had serial casts between the ages of 3.7 to 9.5 years. Six subjects had no further treatment while the other seven subjects went on to surgical lengthening of either TA or calf (average age 10.7 years). All participants underwent 3-D gait analysis and heel-rise test. Average follow-up was 10.8 years (range 5.4–15.6 years). Three patients still had signs of toe walking on visual observation of their gait. The maximum ankle dorsiflexion in stance averaged 90 on 3-D gait analysis (range 20 to 140). Eleven subjects showed maximum ankle dorsiflexion in stance greater than 2 standard deviations below normative values. Nine subjects had abnormal timing of maximal ankle dorsiflexion in stance with maximum ankle dorsiflexion prior to 50 percent of the gait cycle. Only two patients had ankle push off powers below normative values of 2 watts/kg.

This is the first study to report on adults treated for idiopathic toe- walking as children. Most subjects showed restricted range and altered timing of ankle dor-siflexion in gait, however this was detectable visually in only three subjects.

Prophylactic pinning of the contralateral hip remains controversial in the management of unilateral SUFE. This paper reviews our experience, with particular reference to the fate of the non-operated hip.

We reviewed the charts and radiographs of 218 patients who were admitted to Starship Children’s Hospital between 1988 and 2000 with a diagnosis of SUFE. Of the 211 patients with data sufficient for analysis, 168 (80%) had unilateral hip pinning and 43 (20%) had bilateral pinning. 32.8% of patients with a unilateral slip were subsequently readmitted for pinning of the contralateral hip. The time between the two operations averaged 7.5 months and did not vary with race or gender. European females had an almost 50% readmission rate for pinning of the opposite hip while Maori females had the lowest readmission rate (15%). All European females less than 11.5 years with unilateral slips returned for pinning of the opposite hip. 28 of the initial unilateral hip pinnings were for an unstable SUFE. Only 8 of the 28 patients were readmitted for pinning of the opposite hip, all with stable slips. Only one patient with a stable first slip presented with an unstable second slip.

Despite a high incidence of bilateralism, this study shows that it is very uncommon for a patient to present with an unstable second slip. Prophylactic pinning can have complications. We therefore recommend follow-up rather than prophylactic pinning for patients presenting with unilateral SUFE. Caucasian females less than 11.5 years represent a group at high risk of a second slip.

To determine whether elderly patients presenting with a fracture of the proximal femur have an underlying vitamin D deficiency.

We identified 59 consecutive cases of a fracture of the proximal femur over a 10-week period. 16 patients were excluded as they had a secondary underlying cause of bone loss which included chronic renal disease, rheumatoid arthritis, thyroid/parathyroid disorders, long term steroid usage and malignancy.

Of the 43 that were eligible for the study, 7 were men and the average age was 81 years. 9 had sustained previous osteoporotic fractures. The majority mobilised independently or with 1 stick prior to the fall and the mechanism in all cases was a low velocity injury from standing height or less.

The mean vitamin D3 level in these cases was 28. 3 nmol/ l. 28 of the 43 had a pathologically low level of vitamin D3 as defined as < 30nmol/l.

The mean PTH level was 53. 7 nmol/ l. 15 of the 43 had an elevated PTH and all 15 were also deficient in vitamin D.

The mean Albumin, an indicator of nutritional status, was 29 g/l.

This study highlights that 65% of the patients who present with a fracture of the proximal femur are depleted in vitamin D. The ageing process is associated with a reduction in the intake of vitamin D, gut absorption and its sunlight activation. Repletion of vitamin D and suppression of parathyroid hormone, both prophylactically or at the time of injury, may reduce future fracture risk and assist in fracture repair.

We used dual-energy X-ray absorptiometry (DEXA) to compare the bone mineral density (BMD) of nine children aged from 2 years 7 months to 13 years 5 months who had mild osteogenesis imperfecta with an age- and sex-matched control group. The patients had only mild clinical symptoms but DEXA detected highly significant differences in BMD between them and the controls. The mean BMD in the children with osteogenesis imperfecta was 76.7% of normal in the lumbar spine (p < 0.001) and 71.2% of normal in the femoral neck (p < 0.001). DEXA is an objective, reproducible and sensitive method of measurement of BMD in children. It may help to establish the diagnosis, to assess prognosis and possibly to monitor the response to different types of treatment.

Specimens of femoral cortical bone from normal subjects and from patients with osteoporosis were mechanically tested in tension to destruction. The osteoporotic bone showed less strength and less stiffness than the normal bone; these reductions are related to the increased cavity area in osteoporosis. Further, the osteoporotic bone is not able to absorb as much energy before fracture as the normal bone; but this difference is not related to changes in cavity area.

1. A method is described for measurement of the vertical load carried by different areas of the foot while walking barefoot. The results of tests on fourteen subjects, seven with some foot abnormality, are reported.

2. The results show that the load carried by the normal midfoot is low. Measurements in this area could be useful in the quantitative assessment of some foot abnormalities.

3. Considerable variation between individuals is seen in the distribution of vertical load across the forefoot. The metatarsal bones do not necessarily carry loads in proportion to their size.