General
Each person has his or her own gait. “Shuffle”, “waddle gait” or “walk over the big uncle” are just a few colloquial terms for gaits that can make a person unique. Most people who hear one of these terms, however, move within the normal range of gait diversity despite the variety.
The typical gait of small children is also unmistakable when they turn their legs inwards (=internal rotation) and walk in the so-called internal rotation gait, colloquially “over the big uncle”. The toes then typically point towards each other when walking. This makes children look very cute, and up to the age of four this is also completely okay and normal if the child has a normal hip development. This early form of internal rotation in children is completely harmless and usually recedes completely spontaneously and without medical intervention.
My child shows an internal rotation gait – how dangerous is that?
Only when a healthy child retains this gait pattern after the age of four is there a need for clarification, because only then is it a clinical picture that can lead to the development of various long-term unfavorable consequential damages, which are accompanied by late damages such as chronic pain and premature joint wear (arthrosis). Even when children have passed this “magic age threshold”, the gait pattern disappears on its own in 90% of children, at the latest when they are fully grown, and no treatment is required. However, if there is an organic cause, such as hip joint dysplasia, it should be treated accordingly to avoid further late damage associated with the clinical picture.
Causes
The causes of internal rotation are manifold. The most common cause is a forward rotated acetabulum (coxa antetorta). The acetabulum (lat.
: acetabulum) forms the cavity in the pelvic bone which surrounds the femoral head and in which it can move like a ball joint. The hip joint connects the trunk with the legs. It is here that the transmission of force takes place through many bones, muscles and joints, and it is here that the optimal stability of the gait is achieved.
Disorders in this area affect the statics of the entire body. If this cavity in the pelvic bone is now too far forward, as is the case with the coxa antetorta (coxa = hip; ante = forward), the position of the entire leg in relation to the body changes. Because of the front position, the head of the femur and the acetabulum no longer fit together optimally as long as the legs are straight and the patella and feet are parallel, as is normally the case.
To function properly as a ball bearing, the child must turn the leg inwards to achieve the optimal position of the femoral head in the socket. Externally, the child’s inner rotation occurs, visible by the kneecaps and feet pointing towards each other. Another cause is the congenital malposition of the hip joint, the so-called hip dysplasia.
In this case, the hip cups are not correctly positioned during the child’s development and the ball joint cannot be formed in its optimal shape. In the maximum variant, the head of the femur cannot protrude into its counterpart, the acetabulum, at all and move there and is even outside the joint. Infants attract attention early on because they cannot spread their legs and the folds in the groin look different.
This disorder often occurs in families and can be diagnosed at an early stage with an ultrasound examination and treated with splints. These press the head of the femur against the pelvis so that a suitable cavity is formed there over time. This cave often does not form at the optimal position in the pelvis and the rotation of the whole leg results in the image of the internal rotation.
If it is not the hip that is to blame for walking over the big uncle, the leg itself is also a possible culprit. The hip and thigh can be completely healthy, but the lower leg below the knee joint can be rotated and even then the children walk in the internal rotation gait. Fractures (= fractures) can also grow together again in a twisted way and thus force the leg into the rotation position.
In this case, the unilateral internal rotation is more likely to occur. Less frequent causes of the congenital internal rotation gait are clubfoot or hollow foot.The child’s hips, thighs and lower legs are completely healthy. The cause lies in the deformation of the foot itself. This is why completely different forms of therapy are used here than for hip-related internal rotation malpositions, which will not be explained in detail here. Paralysis caused by various brain damages can also typically be accompanied by the internal rotation process and is usually treated in the course of very intensive physiotherapy.
