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Dr Hive- In-Toeing and Twisted Femurs in Older Children? Experience?


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Long story short- sometime, last year, multiple family members noticed that my oldest child was heavily in-toeing while walking. A very heavy pigeon toed walk. 

 

A trip to an ortho doctor told us this child actually has twisted upper and lower leg bones and the degree of internal rotation (if this means anything to anyone) is about 85 degrees, while it is 25 externally. Basically, not normal.

 

We're several months out and I'm noticing that her walk is starting to look painful. One of my friends said she noticed her feet are turning inwards even more now. I'm noticing (when she's walking in a bathing suit) that the upper legs basically rub each other until the knee, where the lower legs then branch out like a Y. 

 

The doctor had told me the only thing they can do (because this is a bone twist issue) is surgery, which they don't suggest unless the child is in pain (or is falling a bunch, etc.). Of course, I definitely do not want surgery for her...but I'm starting to get worried. What if she is in pain, but since this has been a life-long issue, she doesn't realize that most people don't feel that way? 

 

Has anyone ever had experienced with twisted leg bones? My friend suggested getting a second opinion (I can't call our pediatrician because he JUST shut down his office! Grr!), but I don't want to give my child a complex over her problem. 

 

Anyone? I'd love to hear your experience.

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How old is the child? I'd definitely get another opinion, and possibly from a doctor with some sport background. There could be joint issues (hips, knees, ankles) in the future if the upper and lower legs are not aligned, and sports/running might increase the chance of joint injuries. I'd think long, long term for the child. What does she want to be doing at age 60+ and will she being looking at multiple knee and hip replacements as an older adult. Were it my child, I'd want her to have the option of living an active life-style until she was 80+.

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She is 10. We always joked in the past that she ran like Phoebe Buffet on Friends-- well, before we realized the cause of the running issues (we just thought she was a "free" runner). She absolutely HATES to run and I have a feeling it has to do with this. 

 

She swims and has issues with kicking with straight legs, which, I'm starting to wonder is also a structural issue.

 

She's also been diagnosed with a rare form of scoliosis, but we won't be able to tell anything about that until she hits a growth spurt.

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I'd probably look at the overall back and leg issues with a sports-minded ortho who specialized in children. While it may be good to wait and see for the spine curve, it might be better for the long-term health of the joints to treat the bone issues earlier and not wait until there is pain. If she's already having a negative experience with running and swimming, I'd look into all the possible options available while the bones and joints are still forming.

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I would get this child to a pediatric orthopedist.  Not, just a regular pediatrician.  Or, if you live near a Shriner's hospital, I would go there.

 

This is something that an expert's opinion would be important.

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I would also get a second opinion. With the scoliosis and the other bone issues I would wonder if there might be something else going on. My son has bone issues too, and what I found out is many of these problems get worse with puberty and growth. It is better to know what is going on before it progresses. 

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I would not see a sports medicine orthopedist. I would see someone who specializes in cerebral palsy or scoliosis. That's a fairly common complication with some kinds of CP patients, so an orthopedist who specializes in those kids would see it frequently. I'd absolutely get a 2nd opinion and not from a regular pediatrician, but a surgeon. Most major cities have a pediatric orthopedic practice. I'd go to their website and see if they provide bios for the doctors in their practice and pick the one who mentions CP. 

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Not sure. Just watching her walk the other day made me wonder it. When he was discussing the rotation % I'm not sure if that has to do with hips or not.

My little dd was born with bilateral clubfoot. She has internal only rotation in her hips. She used to run like an eggbeater, but that has straightened out in the past several years. She does have some intoeing, and her knees seem a bit "off". I don't know that any of that is relevant, but it is something to ask about. (Hips)

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My dd9 has femoral anteversion and internal tibial torsion. She can't run quickly, but she's okay. She can roller skate but not blade because blades extend beyond the foot and there really is no avoiding tripping. I think it was good for her to grow up in a house with stairs because her PT said that can be an issue for kids with in-toeing. She does fine on stairs, though she never runs up or down as fast as some kids do. Basically, she was fine once she learned to slow down. She fell quite often until she started PT a couple of years ago. My dh had braces as a child but he is still noticeably bow-legged with in-toeing. 

 

ETA: She had pain occasionally, but we later found out the pain was from a connective tissue disorder rather than being bone- or muscle-related. Perhaps consider taking your dd to a geneticist at some point. We found seeing one to be immensely helpful. 

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