Tibial Torsion

• internal tibial torsion is a non-pathologic variation in normal development, in kids < 5 yo
• rotational deformity caused by internal molding of foot/leg in utero
• child usually brought for prominent intoeing on walking and frequent tripping

Exam:

• flex knees 90 degrees and check relation of medial malleolus to lateral malleolus. lateral malleolus  is normally posterior to medial one. If the lateral malleolus is on the same plane or anterior to the medial malleolus, this infers internal tibial torsion.
  OR can examine in prone position, flex knees 90 degrees and observe thigh foot angle (normally slightly external; if internal then have tibial torsion)
• hips, knees, patella normally aligned; lower legs and feet rotated inward
• draw line from ASIS through mid-patella to foot. If line falls medial to big toe, external tibial torsion is present (outtoeing). If line falls lateral to second toe, internal tibial torsion is present (intoeing). Nl 0-20 degrees of internal tibial torsion; gradually changes to external tibial torsion by childhood.
• XR: no osseous abnormalities
•  

Treatment: usually just time.  remodelling will correct the deformity

 If there is no decrease in the angle or clinical presentation, or there are problems walking, refer to Ortho; they may try to alter sleep position by tying the heels together during sleep or by placing in a special brace.

Pt should not sit with feet on floor, this will inhibit the normal remodelling process. Bracing and special shoes have little effect.