gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

Do patients with posterior and anterior hip impingement and abnormal femoral torsion have In Toeing or Out Toeing?

Meeting Abstract

  • presenting/speaker Till Lerch - Inselspital, Universitätssklinik für Orthopädie, Bern, Switzerland
  • Simon Steppacher - Inselspital Universitätsspital, Bern, Switzerland
  • Inga Todorski - Inselspital, Universitätssklinik für Orthopädie, Bern, Switzerland
  • Florian Schmaranzer - Inselspital, Universitätssklinik für Orthopädie, Bern, Switzerland
  • Patric Eichelberger - Berner Fachhochschule, Physiotherapie, Bewegungslabor, Bern, Switzerland
  • Heiner Baur - Berner Fachhochschule, Physiotherapie, Bewegungslabor, Bern, Switzerland
  • Klaus Siebenrock - Inselspital, Universitätssklinik für Orthopädie, Bern, Switzerland
  • Moritz Tannast - Inselspital, Universitätssklinik für Orthopädie, Bern, Switzerland

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocPO26-88

doi: 10.3205/17dkou831, urn:nbn:de:0183-17dkou8314

Veröffentlicht: 23. Oktober 2017

© 2017 Lerch et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: femoral torsion could be an additional factor of femoroacetabular impingement (FAI) in young and active patients with hip pain. In the literature, In-Toeing of the foot is associated with elevated FT. Low FT is combined with anterior FAI while elevated FT can cause posterior extraarticular ischiofemoral hip impingement. It is unknown how femoral torsion influence gait and foot orientation in patients with FAI. We questioned

1.
What is the foot orientation in FAI patients with normal, low and elevated FT?
2.
Does foot orientation differ between FAI patients normal, low and elevated FT?
3.
Is In-Toeing of the foot a specific sign for patients with posterior FAI and elevated FT?
4.
How many patients with elevated FT have In-Toeing?

Methods: A retrospective, IRB-approved, controlled study of 59 symptomatic FAI patients (100 hips) was performed in the gait laboratory. All patients had a CT scan to measure FT Out of symptomatic FAI patients, we selected patients with normal, low and elevated FT and measured foot orientation using dynamic gait analysis.Low FT was defined < 0° and elevated FT >35°.

1.
28 hips (17 Patients) with low FT and anterior FAI had a mean FT of 3° (-6° - 10°). 45 hips (26 patients) with elevated FT and posterior FAI had a mean FT of 43° (28° - 65°). 37/45 hips ad FT >35°.
2.
The group of patients with normal FT consisted of 28 hips (16 patients). Mean TT was 29° +/-7°.

Foot orientation was measured dynamically by the Foot progression angle (FPA) using an optical motion capture system at 200 Hz with 10 infrared cameras and 3 reflective markers for each foot.

Reference for determining the FPA was the line connecting the marker at the calcaneus and the midpoint between the markers at MTP 1 and MTP5. FPA was defined as the angle between this reference line and the direction of gait progression. FPA was calculatedduring the foot flat phase. In-Toeing was defined as FPA <5° and severe In-Toeing was defined as FPA <0. Statistical analysis was performed using analysis of variance (ANOVA) and Chi-square test.

Results:

1.
The mean FPA was 7 +/- 5 in FAI patients with normal FT.
2.
The mean FPA differed between patients with low FT (13 +/-7) and patients with elevated FT (5 +/-5), p<0.001
3.
100% (8/8 hips) of hips with severe In-Toeing (FPA< 0°) have posterior FAI and elevated FT >35°.
4.
51% (19/37 hips) of all patients with FT >35° had a normal FPA (5-15); 27% (10/37 hips) had Intoeing (FPA 5-0); and 22% (8/36) had severe Intoeing (FPA < 0°).

Conclusions: Patients with posterior FAI walked with more internal foot orientation compared to patients with anterior FAI. Severe In-Toeing is specific for elevated femoral Torsion >35°. But half of the patients with elevated femoral torsion had normal foot orientation. Elevated femoral torsion can even be present in the absence of In-Toeing and can easily be missed in patients with normal foot orientation. In-Toeing can detect elevated femoral Torsion.