Hip rotation degrees, intoeing problem, and sitting habits in nursery school children: an analysis of 1134 cases

Objectives: We investigated hip rotation degrees, frequen¬cy of intoeing problems, and sitting habits in nursery school children and the relationship between these parameters. Methods: The study included 1,134 children (612 boys, 522 girls), aged between three to six years, attending 26 nursery schools in the central area of Afyon. First, informed consent was obtained from the parents and a questionnaire was administered about demographic data and sitting habits of the children. Then, the children were examined in lower under¬wear. Foot progression angles were determined and progres¬sion to midline during walking was evaluated as intoeing. Internal and external rotation degrees of the hips were mea¬sured using a goniometer in prone and supine positions. Results: In girls, internal rotation of the hip was nearly 13 degrees greater in the prone position, and 9 degrees greater in the supine position compared to those of the boys. Intoeing was detected in 67 children (5.9%), 76.1% being bilateral. The girl-to-boy ratio was 2.4/1. Intoeing problem originated from the femur in 74.6%, and from the tibia in 25.4%. Compared to normal children, intoeing was associated with a greater internal rotation and a smaller external rotation of the hip. Overall, 36.7% had a crossed-leg sitting habit, and 63.3% had a television sit¬ting habit. The latter was more frequent in intoeing chil¬dren (p=0.001). Conclusion: Although hip rotation degrees in our study were similar to those reported in the literature, higher hip internal rotation degrees were found especially in girls. Television sitting which is a frequently preferred position among nursery school children was significantly preva¬lent in intoeing children.