Ballet Training in Children With Idiopathic Coxa Antetorta

Effects of Ballet Training on Kinematics and Subjective Parameters in Children With Idiopathic Coxa Antetorta: a Randomized Controlled Trial

This study looks at how ballet training affects movement and personal feelings in children with a condition called idiopathic coxa antetorta.

Study Overview

• Status: Completed
• Conditions: Femoral Anteversion
• Intervention / Treatment: Procedure: Balett Training

Detailed Description

Increased femoral anteversion (IFA) occurs when the top of the thigh bone tilts forward more than normal. Many healthy kids and teens aren't considered to have a problem with this as long as they show no symptoms, since it often corrects itself by the time they reach ages 12 to 14. However, experts believe this condition might lead to complications later in life. Research indicates that children with IFA may be more prone to issues like kneecap misalignment, knee pain, and even arthritis as they grow older. This is likely due to the way their knees bend differently when they walk. Kids with IFA often walk with their toes pointing inward, which increases their chances of tripping and falling. They may also experience pain that interferes with their daily activities. It is assumed that strengthening the hips and improving hip flexibility could help reduce the need for compensatory movements, ultimately lowering the risk of tripping, falling, and experiencing pain in everyday life. This study is a randomized controlled trial aimed at examining how ballet training influences knee movement-specifically knee flexion-during walking in children with idiopathic coxa antetorta. The goal is to determine whether ballet training enhances the children's overall mobility and how they feel about their ability to move. Additionally, the study seeks to find out how this training can be effectively incorporated into the daily routines of affected schoolchildren.

• Study Type: Interventional
• Enrollment (Actual): 5
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Switzerland
  • Basel, Switzerland, 4031
    • Universitäts-Kinderspital beider Basel (UKBB)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Diagnosis of idiopathic coxa antetorta with FNA> 30°
• Children between 8 and 12 years of age
• Cognitive abilities must include: Ability to actively participate in a 60-minute ballet class; Ability to communicate pain or discomfort; Ability to attend training, testing and follow-up sessions. All included participants can make decisions on their own and do not show any signs of mental or cognitive limitations.

Exclusion Criteria:

• Any surgery within 6 months prior to the start of the study or surgery scheduled during the study period. Other medications can be continued as prescribed by the participants' physician
• Known cardiovascular or pulmonary diseases that have not received medical clearance to participate in the physical exercise intervention
• Neurological or other musculoskeletal comorbidities
• The children should not have completed any ballet training in the last 12 months
• Pregnancy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Ballet training; The children in this arm of the study will receive ballet training.	Procedure: Balett Training; The ballet training will happen twice a week for six weeks, with each session lasting 60 minutes, for a total of 12 sessions. These sessions will be held in groups of 10 to 12 children and led by experienced ballet teachers. The classes will follow a beginner-level ballet routine, introducing the kids to ballet techniques in a fun and playful way, making sure they learn the movements step by step. Each lesson will follow the same structure, allowing the children to improve their skills week after week. In addition to the group sessions, the children will be given a 10-minute daily home exercise program. This will include simple ballet exercises they learned in their first class, which they should practice on the five days when they don't have ballet sessions. The children will track their practice in a child-friendly diary designed just for them.
No Intervention: Control group; The children in the control group in this study will not receive any intervention, according to the German guidelines for idiopathic coxa antetorta 2002. This is in line with the standard approach, as children in this developmental phase typically do not receive therapy for this condition.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Kinematic measurement and	This study will track knee flexion during the mid-stance phase of walking, as children with coxa antetorta often show increased knee bending, which can lead to future knee issues. The children's walking will be recorded using a 2D gait analysis system on the C-Mill treadmill, offering accurate results while minimizing stress and reducing the chance of errors.	Week1 and week 8
Subjective functional mobility	The children's mobility and quality of life will be assessed, using the parent-reported Pediatric Outcomes Data Collection Instrument (PODCI), a reliable questionnaire designed for children with musculoskeletal conditions. It measures various aspects of daily functioning and well-being, and the scores range from 0 to 100, with lower scores indicating more difficulties.	Week1 and week 8

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Gait Analysis	Gait analysis will be performed on the C-Mill by Motek treadmill. To ensure safety while determining the speed at which a stumble might occur, the children will be secured with a harness to prevent falls or injuries.	Week1 and week 8
Measurement of femoral anteversion angle (°)	The femoral neck anteversion (FNA) will be measured using Craig's test, where we assess the angle at the prominent part of the hip while the child lies face down with their knee bent.	Week1 and week 8
Measurement of hip strength (N)	The maximum strength of the hip flexors, extensors, external rotators, and abductors will be measured using dynamometers, which are reliable tools for checking how strong these muscles are.	Week1 and week 8
Measurement of hip mobility (°)	The passive range of motion for internal and external rotation will be measured using a goniometer while the participants lie face down with their hip straight and knee bent at a 90° angle.	Week1 and week 8
Feasibility assessment	To evaluate how feasible the intervention is, the number of training sessions the children actually attend will be tracked and compared to the planned sessions and calculate the attendance rate. The ballet teacher will maintain an attendance list, and the children will also record their participation in a specially designed, child-friendly diary.	Week 8

Collaborators and Investigators

• Sponsor: University Children's Hospital Basel
• Investigators: Principal Investigator: Michèle Widmer, Dr. med., Universitäts-Kinderspital beider Basel (UKBB)

Study record dates

Study Major Dates

• Study Start (Actual): August 8, 2024
• Primary Completion (Actual): April 30, 2025
• Study Completion (Actual): April 30, 2025

Study Registration Dates

• First Submitted: October 14, 2024
• First Submitted That Met QC Criteria: October 17, 2024
• First Posted (Actual): October 18, 2024

Study Record Updates

• Last Update Posted (Actual): May 18, 2026
• Last Update Submitted That Met QC Criteria: May 14, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Physical activity intervention; Increased femoral anteversion (IFA); Idiopathic coxa antetorta; Childhood knee pain; Ballet training for children; Hip strength and mobility; Knee flexion in children; Exercise for hip flexibility; In-toeing gait in children
• Other Study ID Numbers: 2024-00689; ks24Widmer

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No