- 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
- 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.