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Andrew M. Ball, MS, PT -> Re: Femoral Anteversion (August 14, 2000 2:52:00 PM)
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David,
Good question, it's hard to come up with a good answer though. There are so many factors to consider:
Is the problem truly one of femoral anteversion, or is the following sequence seen?
Poor abdominal control during the 4th to 5th month of development limits weight shifting and reaching in prone. As a result glut max is not developed properly and, hip flexors don't lengthen. In an effort to gain stability however, hips externally rotate in prone and the TFL tightens.
When the child finally gets to standing, an excessive APT is seen, scaps are retracted (in an effort to compensate for poor rectus abdominus control and stablize the trunk), and legs internally rotate and hips "sag" into flexion (because the glut max was never developed properly), creating the illusion of femoral anteversion.
Sometimes when kids have poor recuts control, they sit in a W-sit in order to gain stability. Some PT's claim that doing this furthers the progression of the femoral anteversion, though I've never seen any literature to actually support this assumption. In fact, it's nearly impossible to sit in that position if your femurs weren't anteverted in the first place.
That's usually where I start, and then eventually bring in orthotic intervention if I'm not getting anywhere with the top-down approach (e.g some PT's have a ground-reaction force approach - I reject this for kids, because it runs counter to development, but I'm not aware of any outcome studies comparing the two approaches).
From an impairment level approach, I'd suggest looking for an etiology, and it's usually the recuts abdominus and glut max.
I'd question why you'd want to bother with therapy at the impairment level though. What is it that this child can't do during normal play or daycare routines? If for example, the kids never sit in tailor sit for circle time, but rather short-sit on little chairs . . . then no functional limitations exist and therapy cannot be justified for giving the child tailor-sit abilities. If the child is expected to tailor sit in order to attend to circle time, or play with a sibling . . . that's a different story entirely.
Hope that gives you a little to chew on. Let us know what develops in terms of functional limitations and how you choose to approach this child.
Best of luck,
Drew
[This message has been edited by Andrew M. Ball, MS, PT (edited August 14, 2000).]
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