Practical Examination - In-toeing and Out-toeing

After proper exposure from umbilicus to toes with an inner  wear


Check height and weight which might clue bony displasia or metabolic diseases


Gait - see foot progression angle (Angle between foot print and line of walking )

           normal angle is -5 to +20 degrees

          -5 to -10 mild , -10 to - 15 moderate

           > -15 degrees severe


Look - Leg length discrepancy , any noticeable deformities or muscles wasting

           Check Trendelenburg test during standing position


Feel - any tenderness on soft tissue or bony tenderness

Movement


Special test on prone position with a pillow on chest

 Hip rotation

          Knee in 90 degree flexion , check Hip IR and ER

      Normally Hip IR < 70 degrees , ER < 30 degrees

         meausre Anteversion angle

            Birth ; 40 degrees

            9 years  ; 20 degrees

           16 years ; 16 degrees


    Thigh foot angle

      normally ; 0-20 degrees

      measure tibial and hind foot rotational status


  Transmalleolar thigh angle

         measures tibial torsion only

        normally 0 -40 degrees  .



suspect any pathology when there is

  pain , limp , LLD , asymmetry , rapid changes in rotational profile.