Kids Alignment and Gait Correction

What is often overlooked in kids’ posture is the tibia (bone). The tibia sits between the ankle and knee joint and surprisingly has a wide scope of variation in anatomical shape. In the ideal situation the tibia has a gentle outward twist in the order of 17 degrees. In the correct posture the feet angle out slightly, and the knees point straight ahead.

In toed children generally will compensate by externally rotating their femur and knee joints creating tightness around the posterior hip muscles. This may present as tight hamstrings and aching legs. Kids will walk with the feet turned in, or the knees pointing out (or both). In some cases, children will grow out of this condition but in many cases this does not happen. I see many adults with In toed tibias with resulting torsional problems especially affecting the hips.

Treatment (orthotic therapy) is highly successful, and we often see changes in tibial torsion at the rate of one degree per month. Myofascial release and home-based stretching/strengthening is an excellent adjunct to therapy. All available at EastWest Physiotherapy.

What is often overlooked in kids’ posture is the tibia (bone). The tibia sits between the ankle and knee joint and surprisingly has a wide scope of variation in anatomical shape. In the ideal situation the tibia has a gentle outward twist in the order of 17 degrees. In the correct posture the feet angle out slightly, and the knees point straight ahead.

Out toed children generally will compensate by internally rotating their knee joints creating misalignment of the patellofemoral joint. You may also see an increased anterior pelvic tilt. Kids will walk with the feet turned out, or the knees pointing inwards (or both). In some cases, children will grow out of this condition but in many cases this does not happen. I see many adults with out toed tibias with resulting torsional problems especially affecting the knees.

Treatment (orthotic therapy) is highly successful, and we often see changes in tibial torsion at the rate of one degree per couple of months (slower than intoers). Myofascial release and home-based stretching/strengthening is an excellent adjunct to therapy.

The condition occurs most commonly in children between the ages of 8 and 14 years. Severs Disease is characterised by activity-related pain that occurs on the back of the heel, where the Achilles attaches on the heel bone which is alleviated when the child walks on their toes. The child may have swelling in the area, and tenderness to the touch. Sports requiring lots of running, jumping, and other high impact activities are particularly associated with Severs. Kids that are prone to Severs are usually very active, are having a growth spurt, have tight calf muscles, may be in-toed or out-toed and may be pronators. Treatment starts with load management, anti-inflammatory modalities, (e.g., ice, cold laser), biomechanical analysis, myofascial release and possibly orthotic therapy when indicated

During your child’s adolescent growth spurt, his or her bones grow rapidly. (Usually between 9-16 years) If your child is involved in a lot of running and jumping activities during this time, he or she is at risk of developing Osgood-Schlatter disease (tibial tuberosity apophysitis), an overuse syndrome that causes pain, swelling and tenderness just below the kneecap where the patella tendon inserts onto the tibia. Short term rest, anti-inflammatory modalities, and orthotics to minimize biomechanical stress are prescribed. We find a high proportion of kids with Osgood-Schlatter disease are also in-toed. A condition easily managed with orthotics. Much like the work of orthodontists with teeth alignment.

Sinding-Larsen-Johansson (SLJ) syndrome is pain at the bottom of the kneecap (patella) where it attaches to the patella tendon. It is caused by swelling and irritation of the growth plate there. A growth plate is a layer of cartilage near the end of a bone where most of the bone’s growth happens. It is weaker and more at risk for injury than the rest of the bone. Kids are at risk of SLJ when they play high impact sports (lots of running and jumping), grow quickly, increase their activity levels quickly and have underlying biomechanical faults. Treatment includes load management, local anti-inflammatory modalities, a biomechanical assessment of gait and posture, identification of tight or weak muscles/nerves. Commonly out-toeing affects the forces at the patellofemoral joint. If this is present orthotics with a gait plate is indicated to remodel the tibial torsion.

Kids complain of growing pains regularly. It is worth getting an assessment if the condition is persisting and is preventing your child from being active. Commonly the child is going through a growth spurt in the long bones and the myofascia is having a hard time keeping up with the elongation. My advice is to try hot Epsom salt baths and stretching exercises. If this is not working, there may be an underlying postural issue that needs specific management. Treatment often involves custom orthotics to place the feet and legs in the most efficient posture, myofascial massage, acupuncture, dietary therapy and stretching exercises.