Apr 19, 2010

Tibial Torsion

Except when it's to avoid a much-needed bath or when its away from me in the busy shopping mall while I'm desperately trying to get some errands done, I pretty much love seeing children run. So young and carefree. The life. So really.. what could be wrong with this picture?

a closer look

If you're quite the observant one, you would notice that Tato's right foot curves in way more than usual. Something that we noticed when he was barely a few months old. It became more and more obvious when he started taking his first steps. The books and sites I checked online said it was perfectly common and would correct itself eventually. Never happy with doing nothing, I did some massaging and inverted his shoes (left on the right, right on the left). Two years and many, many bruises from tripping over himself later, it was time for Plan B. GrandDad Doc referred me to Dr G, one of the best orthopedic surgeons around. Tato loved this doctor visit. When else would he be given the go-signal to run up and down the clinic halls without Mommy screaming at him to "Stop. Right Now!"? After a careful physical exam and more running up and down the hall so the doctor could observe his stride, verdict was out. Tato has internal tibial torsion. We were sent on our way with the advice to get him into sports where he could run a lot and "stretch his legs". He said it would correct itself in due time.

What exactly is tibial torsion?
Tibial torsion is an inward twisting of the shin bones (bones located between the knee and ankle). Tibial torsion causes the child's feet to turn inward, or have what is also known as a "pigeon-toed" appearance. It is typically seen among toddlers. Tibial torsion can occur due to the position of the baby in the uterus. When the child is first learning how to walk, tibial torsion can create an intoeing appearance. As the feet toe in, the legs look like they are bowed. The bowed leg stance actually helps children achieve greater balance as they stand. The twisting of the shin bones usually improves with time. As the child grows, walking will become more normal, usually around 5 to 8 years of age.

Thank you for the info, Boston Children's Hospital.

So...tibial torsion is generally caused by living in close quarters in the uterus. Two boys, six pounds apiece, one belly. Go figure. Meanwhile I'm supposed to sit back and wait. And wait we did. But when the tripping became even more frequent and I wanted to avoid accidents such as these, we went to yet another specialist. And so our adventure took us to Doctor R with his decades of practice and his equally vintage-y office. I answered some questions and he measured Tato's legs. He recommended corrective shoes - leather kicks with weights inside - to literally help straighten out the problem. Ice skating and roller skating were also suggested. Apparently these hobbies encourage the feet to turn out. Tato was fitted. Shoes would be ready for pick up in a week.

And so I learned that there are two opposing philosophies here. Why can't we all just get along? The more modern doctors do not advocate intervening. They prefer to "let nature take its course". The more traditional ones like to "set things straight". Apparently when all the hoopla about the corrective devices - splints and bars - came out decades ago, they failed to do a control study. So yes, there were improvements because of them. When a controlled study was done years later, they found out that there were just as many positive results that came from simply doing nothing. My favorite pediatrician on the web, Doctor Greene, has some interesting points on tibial torsion here. In a nutshell, he recommends seeing a specialist and possible intervention IF the rotation worsens, IF your child is tripping even more frequently or IF your child experiences pain wearing shoes or while walking. (Added trivia still from Dr. Greene: The world's best sprinters are generally in-toed more than the average population.)

I initially thought it would be a pain (in more ways than one) to get Tato to wear his shoes. On the way home from the doctor, I explained we were all helping him so he wouldn't fall all the time and that we think we found just the solution. "Magic Shoes". Tadah! He was ecstatic and couldn't wait to wear his "magic shoes" and tell everyone about it. He wears the shoes to school everyday with no hesitation and in a little less than a year we have seen marked improvement. The only problem we encountered was that Mak started walking around the house sideways (visualizing a crab would help here) shortly after. "Mama, look at me. I need magic shoes also". And so after a quick trip to the the "clinic (department store) and a consult with the "doctor" (sales associate) , I came home with Mak's "magic shoes" (placebo) from good ole' SM Department Store. And we've lived happily ever after. So far.

Mak's shoe on the left. Tato's corrective shoe on the right


RONE said...

You know that I am living proof that the old school way doesn't work. Several years of corrective shoes, corrective inserts and inverted shoes and my left foot still is 'pike'. When I was around 11 or 12 I learned how to make a conscious effort to make my foot straight while walking. But as soon as lie down, in it twists. When I'm tired it also shows as I guess I don't make the effort anymore. Anyway, sorry for the novel comment.

Nana said...

Rone, I remember! But, but.. did you read my piece of good news? You may just as well be a shoo-in for a medal at the next running event. Join na

Rone said...

When I was little ballet was the way to go, now sports. Neither are exactly things I do with ease or joy. Imagine me in ballet class???? LOL!

Cely said...

Don't know if you remember, but Emma was born with mild hip dysplasia. I got two different opinions too. I said 'no' to surgery and 'yes' to the old method. She has worn a harness the first 3 months of her life and now, my little girl is fully recovered!
Well, all this to say that it's always difficult, for us parents, of wading through different medical opinions. And I can imagine how you felt.

Magic shoes are magic! I'm SO happy you've already seen improvement and I'm sure that things will get even better for Tato, now! He's a brave little boy!

Oh and I laughed at Mak's reaction! So funny! Please hug them from me!

Strategic Stiletto said...

Well, being all Stiletto-minded and all I love that he loves his magic shoes! Roney didn't like the look of hers at all, but she was very good about it for as long as her fashionista self could tolerate it. So take advantage of the cool factor while it's there, and remember your own shoe obsessions (hello, Harry!) when he starts developing his own.
I love the way Mak 'needed' magic shoes too, I can totally picture his sideways crab strides.

Nana said...

Cely, I didn't know about Emma's dysplasia. So happy it all worked out. Hugs done. Thank you!

Nana said...

Strategic T, I do remember Rone's "magic" pair and my Harrys (why oh why did I give names to my shoes?!). We should have kept it. As for tato, he really thinks the shoes look call. Loves that its leather and looks like "dancing shoes". Very Fred Astaire!