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The Association between Idiopathic Clubfoot and Increased Internal Hip Rotation

  • Symposium: Clubfoot: Etiology and Treatment
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Clinical observation suggests the coexistence of increased internal hip rotation in limbs with clubfoot, thereby providing an additional, and perhaps overlooked, site of deformity to account for an intoeing gait in these limbs. Furthermore, assuming a genetic basis exists for exaggerated femoral and/or acetabular anteversion, which are the possible cause(s) for increased internal hip rotation, this association could provide another key to the multifactorial etiology of clubfoot. We asked whether such an association exists and retrospectively reviewed 114 children (178 clubfeet). We then tested for an association between clubfoot and increased internal hip rotation. These rotational measurements were compared with published normative data on torsion in children. In cases of unilateral clubfoot, an additional analysis compared the rotational profiles of the affected and unaffected extremities. Increased internal hip rotation occurred more frequently in limbs with idiopathic clubfoot. In patients with unilateral clubfoot, the affected extremities manifested greater internal hip rotation than the unaffected extremities, whereas the latter showed no difference in internal hip rotation compared with normative values. Clinical evaluation of intoeing in children with a history of clubfoot should include a rotational profile to determine the level(s) of deformity and guide therapeutic intervention.

Level of Evidence: Level III, prognostic study (case control study). See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, Seattle, WA, USA

    John P. Howlett MD

  2. Department of Orthopaedics, Seattle Children’s Hospital and the University of Washington School of Medicine, 4800 Sand Point Way NE, 5371/W-7706, Seattle, WA, 98105-0371, USA

    Vincent S. Mosca MD

  3. Department of Pediatrics, Seattle Children’s Hospital and the University of Washington School of Medicine, Seattle, WA, USA

    Kristie Bjornson PhD, PT

Authors
  1. John P. Howlett MD
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  2. Vincent S. Mosca MD
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  3. Kristie Bjornson PhD, PT
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Corresponding author

Correspondence to Vincent S. Mosca MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Howlett, J.P., Mosca, V.S. & Bjornson, K. The Association between Idiopathic Clubfoot and Increased Internal Hip Rotation. Clin Orthop Relat Res 467, 1231–1237 (2009). https://doi.org/10.1007/s11999-009-0747-4

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  • DOI: https://doi.org/10.1007/s11999-009-0747-4

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