Treatment of Lower Limb Torsion in Children

Background: In 1934 Sir Denis Browne described the use of a bar attached to shoes to treat significant toeing in and out in children. This was standard treatment until the 1970`s when Stahli and Ritter described frequent spontaneous correction. They advised no treatment but corrected residual deformities by subsequent surgical osteotomies.
We agree that spontaneous correction does occur, but only up to age 3 years.

Objective: Moreland in 1980 established that torsion applied on each side of the growth plate readily changes long bone rotation. Based on his scientific studies we have used the modern (Markel) Denis Browne Bar at night to treat significant torsional deviations.

Methods: A standard examination was performed with the patient lying supine. Foot progression was recorded, as was femoral torsion, by observing patellar rotation. Tibial torsion was measured with the knees flexed to 90°.
A Retrospective study of 115 patients treated over the last four years is presented.
Age groups were - 2-3 years: 50; 3-6 years: 38; 6-9 years: 23; 10 years: 4.
Overall, 97 toed in and 18 toed out.
Success requires patient comfort, acceptance and full family participation.
Patients apply stickers to the bar and later color the white shoes, thus personalizing their "special magic night shoes". A short 8" bar permits rolling over.
The Denis Browne Bar is used at night for six months to establish and consolidate the growth plate correction.

Results: Every patient corrected fully or within 5 degrees of normal foot progression.
Two relapses responded to reapplication of the Denis Browne Bar.

Conclusion: Toeing in and toeing out in children up to 10 years of age can be readily corrected by simple pain-free private nighttime splinting, using the Denis Browne Bar.
Cosmetic appearance and function is significantly improved and surgery avoided.