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LOWER LIMB
DEVELOPMENT, OSSIFICATION
TIMELINE, Based on a powerpoint…
LOWER LIMB
DEVELOPMENT
INTRAUTERINE
COMPRESSION
Compression
- due to rapid growth
- last 20 wks
Newborn
- incapable of weightbearing
- due to lower limb position
Hip
- flexed
- abducted
- laterally rotated
Femoral neck
- increased Coxa Valga angle
- 140 - 150 degrees
Knee
- genu varum
- medially rotated
- flexed
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Subtalar & Midtarsal Joints
TRANSVERSE PLANE
FEMORAL POSITION
Femoral Position
- out turned at birth - 60 degrees
- halved by 3 years
- affects ROM
- more external position in early walking
AKA
- Lateral HIp Contracture
- Femoral Anteversion
Femoral Neck
- external position
- 60 degrees in neonate
- angular position
- femoral head & neck
- relative to frontal plane of body
- rotated anteriorly from frontal plane
- axis angles externally to midline of body
- femoral head protrudes anteriorly from acetabulum
Neonate Hip
- 120-150 degrees ROM
- characteristic out-toed gait
- even range by 2-3 yrs
FEMORAL TORSION
Femoral Torsion
- born with internal twist
- goes from 40-12 degrees
- externally unwinds
- only rotate out
- position cancels out torsion in femur
- soft tissue 12 degrees (out)
- bony 12 degrees (in)
= anterior facing knee
Torsion
- long axis of bone
- bony geometry
- not soft tissue
- birth - internal twist
- prox to distal
- gradually externally rotates
- AKA femoral antetorsion
(frequently femoral anteversion!)
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TIBIAL TORSION
- Transverse
angular position
of ankle
Angular difference
Trans-malleolar axis
- axial bisection
- tibia & fibular malleoli
Tibial condylar axis
- condylar axis aligned
parallel to frontal plane
OSSIFICATION
OF THE FOOT
Order
Forefoot before rearfoot
- 1st is distal phalanx hallux
Postnatal
- medial midfoot
Growth
- mainly epiphyseal
growth plates
Regulated by
- pituitary - growth hormone
- circadian rhythm
- genetics
- forces acting on bones
OSSIFICATION
TIMELINE
Femur
Primary
7-8 wks gest
Secondary
Proximal - 2-8 mnths
Distal 8-9mnths
Closure
Prox - 18-19 yrs
Distal - 19-20 yrs
Tibia
Primary
7-8 wks gest
Secondary
Proximal - 8-9 months
Distal - prox 2 mnths
distal 2-7 mnths
Closure
Prox - 13-15 yrs
Distal - 17-19 yrs
Fibula
Primary
7-8 wks gest
Secondary
Prox - 7mnths - 4.5 yrs
Distal - 5mnths - 1.5 yrs
Closure
Prox - 19-21 yrs
Distal - 17-19 yrs
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Metatarsals
Primary
2-4 8 wks gest
1&5 9-10 wks gest
Secondary
Prox - 1st met 3 yrs
Distal - 2 & 5 3.5 yrs
Closure
16-21 yrs
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