9 year old back pain and femoral anteversion

[KayB]

Hi i wondered if anyone had any words of wisdom about a patient I saw today.

She was late and I was unable to carry out an objective assessment but would like some ideas before I do regarding her case.

She (X) is 9 years old and came with mum. The referral stated back pain ?spinal fusion, and left femoral anteversion.... for core stability and hip strengthening.
X has suffered back pain for a year, aggravated by PE and walking 30 mins +. Eased by rest. Sitting - no effect. Xray apparently shows fusion of some vertebrae in her lumber spine but this was at another hospital so I have not seen the Xray and fusion was only question marked on referral.
X's foot also turns outwards. Mum noticed it when she began to walk at 2 years old but she has had no treatment. She is unable to ride a bike etc due to her leg position.

Basic observation (as this is all I had time for):
Slightly overweight
Poor posture in sitting and standing
- sitting in posterior pelvic tilt, flexed spine, poking chin, left leg externally rotated from the hip
- standing flexed at the hips, flat lumber spine (able to correct posture with verbal and physical prompting) Legs adducted. Left leg externally rotated (painful to bring towards neutral), right leg slightly ext rot
Gait - slow, legs adducted and left leg externally rotated, poor swing through bilaterally

Any ideas where I can focus further Ax (obviously necessary) and Rx? so far I have given basic postural advice.

I am working in outpatients and do not see children very often. has anyone tried teaching stabilisation to children and do you think this would be useful?

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[hari priya]

if there is femoral anteversion there will be media femoral and tibial torsion leading to toein and compensatory subtalar supination.appropriate shoe modification may be helpful.as there is posterior pelvic tilt ant pelvic tilt excercises could be helpful

[estherderu]

dear kay,

Children do not have backaches very often.
Children with hyperlaxity can get pains and aches when they " overstretch their joints". I suggest you do a good observation with the necessary tests and if you do not trust the outcome, send your patient to a colleague or specialist to evaluate the source of the backache.

It could be a posture problem, it could also been a structural problem and you would want to know. Making goals for efficient therapy is only possible after a extensive assessment.
The therapy will have to be fun to do and be repeated at home a lot. In the case of a nine year old, that means getting the parents involved for 100% as well.

Hope you find the source of the problems and good luck to you both.

esther

[hall50]

I have a 7 year old with femoral anteversion, I think, which was picked up by a foot specialist when I took him with ingrown toenails. It was also highlighted that he had a posture problem when being measured for ski boots recently. They suggested a foot health centre but I'm not sure that is the right place for him as the problem is not with his feet.
He is quite flat footed with the inside of his ankles tipped inwards. I have always made sure he had good quality well fitted clarkes or Startright shoes.
Should he be seeing a physio instead of a foot specialist
Help