- Intoeing, as a presumptive diagnosis, results in numerous orthopedic consultations.
- Causes of intoeing are most frequently one or more of the following: metatarsus adductus, internal tibial torsion, and femoral anteversion.
- Version: normal variation in axial alignment
- Torsion: any variation beyond two standard deviations of normal
- Clear explanation of the difference between physiologic variations and pathologic anatomy will allow the treating physician to effectively manage expectations.
Very common; one of the most common reasons for a “well child” to visit an orthopedist
No strong evidence, but in some cases, a history of “intoeing that didn’t resolve” is reported
- Most are self-limiting issues but when paired together, can cause significant issues.
- Excessive femoral anteversion and external tibial torsion can result in the so-called “miserable malalignment,” known to cause significant patellofemoral issues.
- In utero, fetuses are subjected to forces that mold feet and tibiae into adductus and internal torsion, respectively.
- Most children are born with a relatively increased femoral anteversion (approximately 45 degrees).
- Tends to resolve and “unwind” as the child develops
- Usually resolves by age 8 to 10 years to the normal adult anteversion of 10 to 20 degrees
Commonly Associated Conditions
May be more common in first-born children (especially metatarsus adductus) as part of the “packaging disorders” such as developmental dysplasia of the hip and torticollis
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Cabana, Michael D., editor. "Intoeing–Tibial/Femoral Torsion." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617654/all/Intoeing_Tibial_Femoral_Torsion.
Intoeing–Tibial/Femoral Torsion. In: Cabana MDM, ed. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617654/all/Intoeing_Tibial_Femoral_Torsion. Accessed June 9, 2023.
Intoeing–Tibial/Femoral Torsion. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult (8th ed.). Wolters Kluwer. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617654/all/Intoeing_Tibial_Femoral_Torsion
Intoeing–Tibial/Femoral Torsion [Internet]. In: Cabana MDM, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2023 June 09]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617654/all/Intoeing_Tibial_Femoral_Torsion.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Intoeing–Tibial/Femoral Torsion ID - 617654 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617654/all/Intoeing_Tibial_Femoral_Torsion PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -