Intoeing
Describe the possible causes of for this child on sitting that way.
Child is sitting on a W-position.
How to assess ?
History inquire about pregnancy ,Birth and Developmental milestones,family history,significant medical history and current concerns.
Causes of In-toeing
Metatarsus Adductus
Tibial Intorsion and
Persistent Femoral Anteversion
Examination
r/o asymmetry in lower legs,any neurological signs of Spinal Abnormality or neurological problems.
Gait - with shoes and Barefoot,don't miss to assess the shoes borders
foot progression angle (N = -5 to + 20 degrees )
Child Prone, torsion profile
Metatarsus Adductus - foot shape in relation to heel bisector line
Tibial Torsion - thigh foot angle (Normal 0-20 degrees )
Tibial torsion is defined as angle between transcondylar axis of proximal tibia and Bimalleolar
axis (normal = 10-25 degrees external rotation )
Femoral Anteversion
IR (> 60 DEGREES, N=20-60 DEGREES) ; EXTERNAL ROTATION ( < 20 DEGREES ,Normal 30-60 DEGREES
Rowe's Method
Measure angle from vertical ( most prominent GT while palpating ) ,normal = 8-14 degrees
Examine Spine and LE Neurology as well as degree of ligamentous Laxity.
Surgical Treatment
its a physiological condition at one end.
even if it doesnot improve ,she may be left as intoeing.
Rarely a functional problem.Just a cosmetic problem.
Surgery is Femoral Derotational Osteotomy.
How to grade Ligamentous Laxity ?
Beighton Score ; 4/9 = positive for laxity.
Increased Finger Extension 2
Increased Thumb extension 2
Increased Elbow extension 2
Increased Knee Extension 2
ability to place Palm on floor 1
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