Back-carrying of children is a culturally accepted method of transport and safekeeping of babies in many cultures. Developmental consequences related to back-carrying practices have not been directly investigated. This study determined the relationship between frontal and transverse plane lower limb (LL) development, and back-carrying practices, in black Setswana-speaking children. In 691 2- to 9-year-old Setswana-speaking children, the tibiofemoral angle, intermalleolar distance, femoral anteversion angle (AVA) and tibial torsion angle (TTA), were measured to determine LL development. Back-carrying practices were recorded with a questionnaire and Classification and Regression Tree (CART) was used for the analyses. Significant (p < 0.001) relationships, between back-carrying practices and LL development, were discovered. Statistically significant greater genu valgum (F(5, 690) = 7.2, p < 0.001), greater internal TTAs (F(9, 684) = 17.8, p < 0.001), and smaller AVAs (F(13, 685) = 5.1, p < 0.001) were observed in children back-carried more frequently than children back-carried less frequently. There are relationships between back-carrying practices and LL development in both the frontal and transverse plane. However, the genu valgum, internal TTA and smaller AVA noted in more frequently back-carried children is still within normal limits, thus no educational intervention in back-carrying methods or durations is required. Further research should determine the exact back-carrying practice factors (age until which the child is back-carried) impacting lower limb development the greatest.

Department of Consumer and Food Sciences University of Pretoria Pretoria 0002 South Africa

Department of Motor Skills Faculty of Physical Education and Sport Wroclaw University of Health and Sport Sciences 51 612 Wrocław Poland

Incubator of Kinanthropology Research Faculty of Sport Studies Masaryk University 62500 Brno Czech Republic

Physical Activity Sport and Recreation Potchefstroom 2520 South Africa

Zobrazit více v PubMed

Pretorius E., Naudé H., Van Vuuren C. Can Cultural Behavior have a Negative Impact on the Development of Visual Integration Pathways? Early Child Dev. Care. 2002;172:173–181. doi: 10.1080/03004430210882. DOI

Graham S.M., Manara J., Chokotho L., Harrison W.J. Back-carrying infants to prevent developmental hip dysplasia and its sequelae: Is a new public health initiative needed? J. Pediatric Orthop. 2015;35:57–61. doi: 10.1097/BPO.0000000000000234. PubMed DOI

Pretorius E., Naudé H. Results from an Empirical Study: The impact of carrying a child on the back on the development of visual integration pathways. Early Child Dev. Care. 2002;172:585–594. doi: 10.1080/03004430215106. DOI

Golding J. The mechanical factors which influence bone growth. Eur. J. Clin. Nutr. 1994;48:S178. PubMed

Stroebel S., De Ridder J.H., Wilders C.J. Postural deformities in children: A review: Sports medicine. Afr. J. Phys. Health Educ. Recreat. Danc. 2009;15:294–330.

Roper A. Hip dysplasia in the African Bantu. Bone Jt. J. 1976;58:155–158. doi: 10.1302/0301-620X.58B2.932075. PubMed DOI

van Meerdervoort H.P. Congenital dislocation of the hip in black patients. S. Afr. Med. J. 1974;48:2436–2440. PubMed

Griffiths J. Dislocated hip in East African infants and children. Postgrad. Med. J. 1970;46:86. doi: 10.1136/pgmj.46.532.86. PubMed DOI PMC

Loder R.T., Shafer C. The demographics of developmental hip dysplasia in the Midwestern United States (Indiana) J. Child. Orthop. 2015;9:93–98. doi: 10.1007/s11832-015-0636-1. PubMed DOI PMC

Espandar R., Mortazavi S.M.-J., Baghdadi T. Angular deformities of the lower limb in children. Asian J. Sports Med. 2010;1:46–53. doi: 10.5812/asjsm.34871. PubMed DOI PMC

Peterson-Kendall F., Kendall-McCreary E., Geise-Provance P., McIntyre-Rodgers M., Romani W. Muscles Testing and Function with Posture and Pain. 5th ed. Lippincott Williams & Wilkins; Baltimore, MD, USA: 2005.

Knight R.A. Developmental deformities of the lower extremities. J. Bone Jt. Surg. 1954;36:521–558. doi: 10.2106/00004623-195436030-00006. PubMed DOI

Leveau B.F., Bernhardt D.B. Developmental biomechanics: Effect of forces on the growth, development, and maintenance of the human body. Phys. Ther. 1984;64:1874–1882. doi: 10.1093/ptj/64.12.1874. PubMed DOI

Omololu B., Tella A., Ogunlade S., Adeyemo A., Adebisi A., Alonge T., Salawu S., Akinpelu A. Normal values of knee angle, intercondylar and intermalleolar distances in Nigerian children. West Afr. J. Med. 2003;22:301–304. doi: 10.4314/wajm.v22i4.28051. PubMed DOI

van Aswegen M., Czyz S., Moss S. The Profile and Development of the Lower limb in Setswana-speaking children between the ages of 2 and 9 years. Int. J. Environ. Res. Public Health. 2020;17:3245. doi: 10.3390/ijerph17093245. PubMed DOI PMC

Omololu B.B., Ogunlade O.S., Gopaldasani V.K. Normal Q-angle in an adult Nigerian population. Clin. Orthop. Relat. Res. 2009;467:2073–2076. doi: 10.1007/s11999-008-0637-1. PubMed DOI PMC

Saini U.C., Bali K., Sheth B., Gahlot N., Gahlot A. Normal development of the knee angle in healthy Indian children: A clinical study of 215 children. J. Child. Orthop. 2010;4:579–586. doi: 10.1007/s11832-010-0297-z. PubMed DOI PMC

Cheng J.C., Chan P., Chiang S., Hui P. Angular and rotational profile of the lower limb in 2630 Chinese children. J. Pediatric Orthop. 1991;11:154–161. doi: 10.1097/01241398-199103000-00003. PubMed DOI

Cahuzac J., Vardon D., de Gauzy J.S. Development of the clinical tibiofemoral angle in normal adolescents. A study of 427 normal subjects from 10 to 16 years of age. Bone Jt. J. 1995;77:729–732. doi: 10.1302/0301-620X.77B5.7559698. PubMed DOI

Arazi M., Ögün T.C., Memik R. Normal development of the tibiofemoral angle in children: A clinical study of 590 normal subjects from 3 to 17 years of age. J. Pediatric Orthop. 2001;21:264–267. doi: 10.1097/01241398-200103000-00027. PubMed DOI

Jacquemier M., Glard Y., Pomero V., Viehweger E., Jouve J.-L., Bollini G. Rotational profile of the lower limb in 1319 healthy children. Gait Posture. 2008;28:187–193. doi: 10.1016/j.gaitpost.2007.11.011. PubMed DOI

Sass P., Hassan G. Lower extremity abnormalities in children. Am. Fam. Physician. 2003;68:461–468. PubMed

Magee D.J. Orthopedic Physical Assessment. 4th ed. Saunders Elsevier; Philadelphia, PA, USA: 2006.

Lewis R.J. An Introduction to Classification and Regression Tree (CART) Analysis; Proceedings of the Annual Meeting of the Society for Academic Emergency Medicine; San Francisco, CA, USA. 22–25 May 2000.