Investigations
1st investigations to order
anteroposterior pelvic x-rays
Test
Ordered when hip examination is marked by pain or asymmetric range of motion, neuromuscular diseases, or gait abnormality that is not easily explained by rotational profile.
Rules out hip dysplasia, slipped capital femoral epiphysis, avascular necrosis of the femoral head, and hip osteoarthrosis.
Result
normal for most torsional deformities
cross-table lateral x-ray of knee and hip
Test
Ordered in a child >8 years of age with a recent change or abnormality in gait, and knee or hip pain.
Rules out hip dysplasia, slipped capital femoral epiphysis, avascular necrosis of the femoral head, hip osteoarthrosis, or Blount's disease.
Result
normal for most torsional deformities
foot x-rays
Test
Taken in the weight-bearing position.
Helps diagnose club foot, skew foot, congenital vertical talus, and hallux valgus.
Order if any foot deformities are noted on examination or if the feet are painful, swollen, or stiff.
Result
normal for most torsional deformities; positive for other causes of in-toeing, such as hallux varus, metatarsus adductus, and club foot
Investigations to consider
3-dimensional imaging
CT rotational profile evaluations
Test
May be used to measure severe or complex torsional deformities, such as miserable malalignment syndrome, in older children.
Result
helps to quantify the location and magnitude of each torsional deformity
Emerging tests
quantitative gait analysis
Test
Provides information on dynamic alignment and range of motion. Primarily reserved for assessing gait abnormalities in neuromuscular conditions (e.g., cerebral palsy) for surgical decision-making.
Result
helps to quantify the location and magnitude of each torsional deformity
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