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Intoeing Gait : Causes and Treatment
Internal Tibial Torsion is a common condition in children less than age 4 which typically presents with internal rotation of the tibia and an in-toeing gait.
Diagnosis is made clinically with a thigh-foot angle > 10 degrees of internal rotation in a patient with an in-toeing gait.
Treatment is observation in most cases as the condition usually resolves spontaneously by age 4. Surgical management is indicated in children > 6-8 years of age with functional problems and thigh-foot angle >15 degrees.
Incidence
most common cause of in-toeing in toddlers
Demographics
usually seen in 1-3 year olds
Anatomic location
often bilateral
Metatarsus Adductus is a common congenital condition in infants that is thought to be caused by intra-uterine positioning that lead to abnormal adduction of the forefoot at the tarsometatarsal joint.
Diagnosis is made clinically with medial deviation of the forefoot with normal alignment of the hindfoot.
Treatment is generally nonoperative with stretching if the deformity can be passively corrected, and with casting if the deformity is rigid. Surgical management is indicated for patients with progressive deformities who fail nonoperative management.
Incidence
occurs in approximately 1 in 1,000 births
equal frequency in males and females
bilateral approximately 50% of cases
Increased incidence in
late pregnancy
first pregnancies
twin pregnancies
oligohydramnios
Associated conditions
DDH (15-20%)
torticollis
Femoral Anteversion is a common congenital condition caused by intrauterine positioning which lead to increased anteversion of the femoral neck relative to the femur with compensatory internal rotation of the femur.
Diagnosis is made clinically with the presence of intoeing combined with an increase in internal rotation of the hip of greater than 70° with an accompanying decrease in external rotation of the hip of less than 20°.
Treatment is observation with parental reassurance as most cases resolve by age 10. Rarely, surgical management is indicated in the presence of less than 10° of hip external rotation in children greater than 10 years of age.
Demographics
seen in early childhood (3-6 years)
twice as frequent in girls than boys
can be hereditary
Anatomic location
often bilateral
be cautious of asymmetric abnormalities
Etiology
Femoral anteversion is characterized by
increased anteversion of the femoral neck relative to the femur
compensatory internal rotation of the femur
lower extremity intoeing
Pathophysiology
a packaging disorders caused by intra-uterine positioning
most spontaneously resolve by age 10
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