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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