Results of Further Study in Leg Rotation

C. L. Lowman
1917 Boston Medical and Surgical Journal  
In continuing the work and observations on faulty weight-bearing in reference to the overstretching and weakening of the external rotators of the thigh, I wish to refer you to the previous articles. The effects on the feet from weight-bearing in inward rotation is considered in the first paper published in the Boston Medical and Surgical Journal, January 18, 1912. Faulty relations in skeletal alignment between the leg and body, produced by relaxation of certain groups of leg and foot
more » ... are taken up in the second paper, entitled "Relation of Foot and Leg Muscles to the Statics of the Body," published in the Boston Medical and Surgical Journal, February 5, 1914. For the past five or six years, particularly, I have been intensely interested in the study of posture in children, in an effort to correct relaxed weak feet which had dropped into valgus, or to raise those that from babyhood had never been anywhere else. I very soon attempted to get away from the use of metal on children in the treatment of these conditions. It is a physiological law that muscles grow strong by being used. When splints prevent their working, as arch supports do, in foot conditions, then weakness is apt to follow unless carefully prescribed gymnastics are carried out to offset this vicious effect. A very high percentage of the posturally relaxed children have faulty foot positions, either congenital or acquired, but usually the latter. They also usually have one or more groups of weakened or overstretched ligaments or muscles, caused by a too rapid growth or increase in body weight, plus a faulty gravity line of the leg, or due to weakness more pathological, as in malnutrition. The treatment of the condition must not be confined to the feet; they are only the foundation. To expect the weakened muscles to hold the foot, even assisted by shoes or arch supports, and thereby control faults in the upper leg and body, is asking a great deal. The force necessary to control a long lever with a short one is so great that we should not consider the foot end of the problem alone. When the thigh droops into inward rotation, from whatever the cause, primarily or secondarily, the weight falls through wrong lines onto the lower leg and foot structures. The control or prevention of this faulty thrust, which increases in direct relation to the degree of deviation, should be the aim in any line of treatment. Torsion deformities in the leg bones and mal-alignment of the joints are induced when this faulty thrust is allowed to go uncontrolled. To be permanently effective and of positive and constructive value in the physical life of the child, the treatment should be broad and comprehensive. Consequently, the body balance and a consideration of its relation to foot and leg postures is necessary. All children should be stripped for examination, although they have been referred only for weak ankles, flat-feet, knock-knees, or bow legs. Then the points of mal-alignment in the back, pelvis and' thighs will stand out and the parents can be shown their effect on the lower segment. Since the body weight falls onto the legs through the pelvis, and the thigh movements are controlled almost wholly by muscles fastened to and near it, in order to control the thighs we must control the pelvis and back. My first experiment in controlling thigh rotation was in a girl of ten with very relaxed, flat feet, for which she had been treated by others for two years. She showed marked pronation with prominence of the inner femoral condyles; inward rotation of the thighs; hollow back, and prominent abdomen. She was made to stand on the outer borders of her feet and a three-inch strip of adhesive was passed over her sacrum and buttocks down across the thighs spirally to the inner condyles. She was then told to let her feet down and found that she could not, but was held in varus and her lumbar curve was flattened. She was allowed to wear this without other support for the feet for a week. She then reported that it had held her about three days before slipping. Appreciating the fact that the soft, sensitive skin over the inner aspect of the thigh could not stand this pull very long, I thought of connecting this control to the upper end of the regular spiral foot strapping ordinarily used for pronation. Thus the thrust or force of the body weight falling on the sling passing under the relaxing arch, reverted back into the pelvis, is used to control the pelvic position. Not being able to keep a patient strapped with adhesive I had an ordinary pelvic girdle made, snugly fitted above the crest and sacrum. Two straps, one and a half inches wide, of folded coutille or strong muslin, were sewed to this girdle. These passed from the midline posteriorly downward, outward, and forward, crossing the thigh anteriorly to the inside of the knee, over the inner condyle, behind the bend of the knee, and outward over the outer aspect of the calf, ending in a buckle at about the junction of . the middle and lower thirds of the leg. Smaller straps of the same material, broader at their distal extremity and tapered at the top, according to the width of the buckle, are tacked in the shoes just back of the base of the fifth .metatarsal. These pass inward under the front of the os caléis and scaphoid, through a slot in the
doi:10.1056/nejm191709271771303 fatcat:2tybk4hfgjahxf7vemzhhysdk4