Consequences
Muscles, ligaments and tendons adapt to this change over time and lose their function. The pelvis can now only be stabilized with difficulty and the transmission of force between the trunk and legs can no longer be carried out effectively. In the long term, this condition becomes noticeable through pain and often through early arthrosis (= wear and tear of the joint).
The rest of the skeleton also suffers from this condition. Due to the changes in the pelvis, the pressure and load on the spinal column also change. The children develop an excessive curvature of the spine in the lower back (hyperlordosis).
This posture of the spinal column tries to compensate for the changed statics of the pelvis. However, this also leads to consequential damage such as back pain, early herniated discs or premature wear of the vertebral bodies and their joints. Furthermore, the knees are exposed to other loads, since they are now also loaded in other places than usual with normal leg position. Early wear and tear due to incorrect loading can also be the result here as with the spine and hip joint (=knee joint arthrosis).
Therapy
The therapy of internal rotation that lasts beyond puberty saves many people from later problems such as pain, arthrosis and possibly a hip joint replacement. Even possible consequences for knee and spine and the rest of the skeletal system can be prevented by simple means. Only in very rare extreme cases may surgery be necessary.
In this operation, the thigh is broken and reattached in a rotated normal parallel leg position, leaving the hip joint itself in its position. Once the diagnosis of the internal rotation requiring treatment has been made, physiotherapy on the one hand and the use of special heels, so-called torqheel heels on the other hand, can bring healing. These special heels are positioned under the child’s heel, either in the shoe or under the sole.
Thus the leg axis is corrected and the inward turned position is straightened. Already after half a year of treatment, great results can be achieved or the gait pattern can be completely normalized. Physiotherapy is also a sensible therapy method.
The indication for a physiotherapeutic treatment should always be determined individually depending on the cause of the internal rotation gait. Physiotherapy is particularly important in combination with Torqheel heels, for example, if the cause of the malposition is a coxa antetorta (= acetabulum rotated forward). Physiotherapy can also be helpful in the case of hip dysplasia as a reason for internal rotation as an accompanying measure to orthopedic means such as a spreader panty.
In severe cases, surgical treatment of an internal rotation gait may be necessary. In this case, physiotherapy is an integral part of the postoperative therapy scheme. Overall, the importance of physiotherapy in the therapy of an internal rotation gait in children is high.
Insoles are not included in the treatment of the internal rotation gait. Since the internal rotation gait in children is a fault in the gait pattern with a very high rate of spontaneous correction, therapy should generally be reserved at first. It is not uncommon for the internal rotation gait in children to regress after puberty.
Even if this should not be the case, wearing orthopedic measures such as an insole makes little sense. This is because the cause is usually an incorrect position of the hip joint, more precisely an increased neck angle of the femur. If the leg position were corrected, the femoral head would then not be sufficiently covered by the acetabulum.
This can result in further complaints, so that children wearing insoles during internal rotation are not helped. However, an insole according to Pomarino, a corrective rotational insole, is useful. However, this is not a conventional insole.It is a modified form of the Torqheel heel: The heels are then not attached under the shoe as they should be, but in the shoe in the insole.