Angular alignment, rotational profile, and joint range of motion in the lower limb of typically developing children from 7–16 years of age: a cross-sectional study
DOI:
https://doi.org/10.2340/17453674.2025.43478Keywords:
Foot and ankle, Hip, Knee, Paediatric orthopaedics, StatisticsAbstract
Background and purpose: We aimed to update reference intervals for anthropometric parameters for the passive joint range of motion (ROM), rotational profile, and angular alignment of the lower limb in typically developing children (TDC), to compare the association of the variables age, left–right sidedness, body mass index (BMI), and sex.
Methods: We conducted a cross-sectional study in a convenience sample of TDC from the 1st, 5th, and 9th grades (6–17 years) in a randomized selection of Danish primary schools. We examined the anthropometric parameters in a non-clinical setting. Descriptive statistics were used to characterize the data. To explore potential differences across the variables, we utilized Bonferroni-corrected Welch’s 2-sample t-tests, one-way analysis of means, and univariable linear regression.
Results: We analyzed the associations between the variables and the anthropometric parameters in 501 TDC, aged 6 to 17 years. We found a statistically significant, but not clinically meaningful decrease in ROM for the hip, knee, and ankle as well as decreased femoral anteversion and increased tibial torsion with increasing age, but no association with sex or sidedness. However, several associations between BMI and ROM measurements were statistically significant and potentially clinically meaningful, with ROM decreasing by approximately 0.4° to 1.2° per unit increase in BMI, particularly for hip, knee, and ankle flexion movements.
Conclusion: Anthropometric parameters remain clinically stable after 7 years of age and are affected only by the BMI but not sex or age. We found a statistically significant but not clinically relevant decrease in torsion and joint ROM with increasing age.
Downloads
References
Staheli L, Corbett M, Wyss C, King H. Lower-extremity rotational problems in children: normal values to guide management. J Bone Joint Surg Am 1985; 67: 39-47. doi: 10.2106/00004623-198567010-00006. DOI: https://doi.org/10.2106/00004623-198567010-00006
Sankar W N, Laird C T, Baldwin K D. Hip range of motion in children: what is the norm? J Pediatr Orthop 2012; 32: 399-405. doi: 10.1097/BPO.0B013E3182519683. DOI: https://doi.org/10.1097/BPO.0b013e3182519683
Lee S Y, Lee S H, Chung C Y, Park M S, Lee K M, Akhmedov B, et al. Age-related changes in physical examination and gait parameters in normally developing children and adolescents. J Pediatr Orthop B 2013; 22: 153-7. doi: 10.1097/BPB.0B013E32835B2E7F. DOI: https://doi.org/10.1097/BPB.0b013e32835b2e7f
McKay M J, Baldwin J N, Ferreira P, Simic M, Vanicek N, Burns J. Normative reference values for strength and flexibility of 1,000 children and adults. Neurology 2017; 88: 36-43. doi: 10.1212/WNL.0000000000003466. DOI: https://doi.org/10.1212/WNL.0000000000003466
Jacquemier M, Glard Y, Pomero V, Viehweger E, Jouve J L, Bollini G. Rotational profile of the lower limb in 1319 healthy children. Gait Posture 2008; 28: 187-93. doi: 10.1016/j.gaitpost.2007.11.011. DOI: https://doi.org/10.1016/j.gaitpost.2007.11.011
Heath C H, Staheli L T. Normal limits of knee angle in white children: genu varum and genu valgum. J Pediatr Orthop 1993; 13: 259-62.
Scorcelletti M, Reeves N D, Rittweger J, Ireland A. Femoral anteversion: significance and measurement. J Anat 2020; 237: 811-26. doi: 1010.1111/JOA.13249. DOI: https://doi.org/10.1111/joa.13249
Kaspiris A, Zaphiropoulou C, Vasiliadis E. Range of variation of genu valgum and association with anthropometric characteristics and physical activity: comparison between children aged 3–-9 years. J Pediatr Orthop B 2013; 22: 296-305. https://doi.org/10.1097/BPB.0B013E328360F9A5. DOI: https://doi.org/10.1097/BPB.0b013e328360f9a5
Staheli L T. Lower positional deformity in infants and children: a review. J Pediatr Orthop 1990; 10: 559-63. doi: 10.1097/01241398-199010040-00027. DOI: https://doi.org/10.1097/01241398-199007000-00027
Mudge A J, Bau K V, Purcell L N, Wu J C, Axt M W, Selber P, et al. Normative reference values for lower limb joint range, bone torsion, and alignment in children aged 4-16 years. J Pediatr Or-thop B 2014; 23: 15-25. doi: 10.1097/BPB.0B013E328364220A. DOI: https://doi.org/10.1097/BPB.0b013e328364220a
Law N H, Li J X, Law N Y, Varin D, Lamontagne M. Effects of body mass and sex on kinematics and kinetics of the lower extremity during stair ascent and descent in older adults. Sports Med Health Sci 2021; 3: 165-70. doi: 10.1016/j.smhs.2021.06.001. DOI: https://doi.org/10.1016/j.smhs.2021.06.001
Spech C, Paponetti M, Mansfield C, Schmitt L, Briggs M. Biomechanical variations in children who are overweight and obese during high-impact activities: a systematic review and meta-analysis. Obes Rev 2022; 23. doi: 10.1111/obr.13431. DOI: https://doi.org/10.1111/obr.13431
Wong C, Bjerge C Y, Jurca A, Petersen M M, Boedtker S, Balslev-Clausen A, et al. Protocol article: A cross-sectional evaluation of children’s feet and lower extremities. Methods Protoc 2023; 6: 115. doi: 10.3390/MPS6060115. DOI: https://doi.org/10.3390/mps6060115
Vandenbroucke J P, Von Elm E, Altman D G, Gøtzsche P C, Mulrow C D, Pocock S J, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and Elaboration. PLoS Med 2007; 4. doi: 10.1371/journal.pmed. DOI: https://doi.org/10.1371/journal.pmed.0040297
Hazlewood M E, Simmons A N, Johnson W T, Richardson A M, van der Linden M L, Hillman S J, et al. The Footprint method to assess transmalleolar axis. Gait Posture 2007; 25: 597-603. doi: 10.1016/J.GAITPOST.2006.06.011. DOI: https://doi.org/10.1016/j.gaitpost.2006.06.011
Ryf C, Weymann A. The neutral zero method: a principle of measuring joint function. Injury 1995; 26: 1-11. doi: 10.1016/0020-1383(95)90116-7. DOI: https://doi.org/10.1016/0020-1383(95)90116-7
De Vet H, Terwee C, Mokkink L, Knol D. Measurement in medicine: a practical guide. Cambridge: Cambridge University Press; 2011. doi: 10.1017/CBO9780511996214. DOI: https://doi.org/10.1017/CBO9780511996214
Saabye T, Colding-Rasmussen T, Balslev-Clausen A, Boedtker S, Wong C, Harsted S. Test–retest reliability coefficients for lower extremity examinations in children using intra-class correlations: an evaluation of 50 children. J Child’s Orthop (accepted for publication).
Wong C, Adriansen J, Jeppsen J, Balslev-Clausen A. Intervariability in radiographic parameters and general evaluation of a low-dose fluoroscopic technique in patients with idiopathic scoliosis. Acta Radiol Open 2021; 10(9): 20584601211043258. doi: 10.1177/20584601211043258. . DOI: https://doi.org/10.1177/20584601211043258
R Core Team (2023). R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; n.d. Available from: https://www.R-project.org/
Dzielska A, Kelly C, Ojala K, Finne E, Spinelli A, Furstova J, et al. Weight reduction behaviors among European adolescents—changes from 2001/2002 to 2017/2018. J Adolesc Health 2020; 66: S70-80. doi: 10.1016/j.jadohealth.2020.03.008. DOI: https://doi.org/10.1016/j.jadohealth.2020.03.008
Ryom K, Christiansen S R, Elbe A M, Aggestrup C S, Madsen E E, Madsen M, et al. The Danish “11 for Health” program raises health knowledge, well-being, and fitness in ethnic minority 10- to 12-year-olds. Scand J Med Sci Sports 2022; 32: 138-51. https://doi.org/10.1111/sms.14057. DOI: https://doi.org/10.1111/sms.14057
Ichihara K, Boyd J C. An appraisal of statistical procedures used in derivation of reference intervals. Clin Chem Lab Med 2010; 48: 1537-51. doi: 10.1515/CCLM.2010.319. DOI: https://doi.org/10.1515/CCLM.2010.319
Whyte M B, Kelly P. The normal range: it is not normal and it is not a range. Postgrad Med J 2018; 94: 613-16. doi: 10.1136/postgradmedj-2018-135983. DOI: https://doi.org/10.1136/postgradmedj-2018-135983
Additional Files
Published
How to Cite
License
Copyright (c) 2025 Christian Wong, Michael Mørk Petersen, Trine Henriksen, Ales Jurca, Soeren Boedtker, Andreas Balslev-Clausen, Steen Harsted
This work is licensed under a Creative Commons Attribution 4.0 International License.
