Pediatric In-toeing & Out-Toeing Management (CTF 2)

Pediatric In-toeing & Out-Toeing Management for Neuromotor Training
• Certified TheraTogs Fitter (CTF) Level II


Course Summary

This program builds upon the foundation laid in the Posture & Torso Alignment (CTF Level I) workshop. It features a brief review of pediatric orthopedic lower-extremity (LE) skeletal and joint development as it occurs in the transverse plane – i.e. medial and lateral joint rotation and medial and lateral long bone torsion – and in relation to deviations in foot progression angle (FPA) – i.e. in-toeing and out-toeing.

Lecture content includes these topics:

  • Transverse-plane (TP) LE skeletal and joint modeling events with rotation strapping precautions
  • A review of elements of postural control acquisition and maintenance that pertain to TP LE bone and joint development and alignment
  • An implementation of SA Sahrmann’s muscle balance theory in the context of the kinesiology of LE rotation strapping applications
  • A review of three musculoskeletal assessment procedures used to identify sources of deviations in FPA and to document changes in a replicable manner.

In the first afternoon lab session, teams of three attendees learn and practice three LE musculoskeletal assessments that pertain to TP alignment and gait problems: hip rotation ROM in hip extension, modified Ryder’s test, and the modified thigh-foot angle. At the conclusion of the first lab, attendees are evaluated on their ability to demonstrate these same assessments.

In the second lab, attendees will be guided through a series of donning and strapping applications using the TheraTogs Lower Extremity system to demonstrate the biomechanical principles and management techniques reviewed in the morning session. Strapping applications include those designed to improve functioning alignment of the femur at the hip joint, and of the leg at the knee joint.

At the conclusion of the lab, attendees are evaluated on their ability to demonstrate these same procedures.

Attendees are under no obligation to use the TheraTogs or Dragonfly orthotic systems in the care and treatment of clients.  Attendees who successfully complete both on-site practicum exams with “passing” scores will receive a Certified TheraTogs Fitter (CTF) Level II credential.

Attendees also receive a complimentary copy of Beverly Cusick’s DVD Legs & Feet: A Review of Musculoskeletal Assessments.


May 20 – Pleasanton, CA

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Course Description (PDF)

Course Objectives

Seminar participants are expected to be able to:

  • Discuss the skeletal modeling process that influences long bone torsion, and explain the modeling “window of opportunity.”
  • Describe the ideal changes in growing bone design that occur in the transverse plane in the pelvis, femur, and tibiofibular segment in children born at full-term gestation.
  • Relate foot position – pronation and supination – to body weight distribution on the feet in standing and walking.
  • Relate toeing in and toeing out to body weight distribution on the feet in standing and walking, and to muscle recruitment strategies needed to maintain the upright position.
  • Explain the role of the Iliotibial band (ITB) and the “deltoid of the hip” in maintaining pelvic alignment and postural control in gait.
  • Describe the influence of a medially-rotated knee axis on ITB alignment and competence.
  • Distinguish between femoral antetorsion and anteversion when using hip rotation strapping.
  • Explain the precautions regarding the use of rotation strapping across the hip and knee joints in individuals aged seven years and older.

Lab participants seeking CTF Level II certification are expected to be able to:

  • Demonstrate novice skill level in executing three musculoskeletal assessments: Hip rotation ROM in hip extension, Modified Ryder’s Test, and the Modified Thigh-Foot Angle.
  • Demonstrate competence in donning an effective TheraTogs PTA system that improves upper trunk extension and reduces excess anterior pelvic tilt.
  • Demonstrate competence in the application of seven trapping applications for improving functioning lower extremity alignment: Hip Extension with lateral rotation (LR), Hip abduction (2 ways), Hip LR, Hip medal rotation (MR), Leg LR, Leg MR.

Disclosure Statement: Beverly Cusick, PT, MS, NDT, COF, the author and principal owner of this training has equity ownership in Progressive Gaitways LLC and TheraTogs Inc. which develops and sells products related to the training being offered.

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