Re: Intoeing and Hyperextension - what to do?
Sounds like you have most bases covered.
One of the most important things in managing intoeing is to establish the level of the 'twist'. From what you say, since the knee is internally rotated, this would indicate that the level of deformity is somewhere at the femur. Is the intoeing symmetrical or or unilateral?
Assuming your patients are showing symmetrical intoeing, given their ages, one could be pretty sure that they both still have a good deal of lower limb development to go-this means 'untwisting' of the offending femur-all normal development. Indeed, it wouldn't be unusual to see quite alot of 'untwisting' in your patients lower limbs over the next 3-4 years or so.
Think carefully about why you are giving your patients orthoses-may be of limited benefit. If anything gait plates might only be any good to get them through the transient phase of tripping more than their peers - even at that, their use might be limited. Maybe monitoring in addition to your other advice is all that is needed.
Perth Royal Infirmary,