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In-Toeing
Aka: In-Toeing, Toeing-In, Intoeing, Pigeon-Toed
- General
- Intoeing encases several underlying leg abnormalities
- Intoeing may occur at any level down leg kinetic chain
- Hip: Medial Femoral Torsion (Femoral Anteversion)
- Leg: Medial Tibial Torsion (Internal Tibial Torsion)
- Foot: Metatarsus Adductus
- Intoeing causes by age (most common causes)
- Infant: Metatarsus Adductus
- Toddler: Internal Tibial Torsion
- Child: Femoral Anteversion (usually bilateral)
- Approach
- Step 1: Evaluate gait and rotational profile
- See Foot Progression Angle (Gait Rotational Angle)
- Confirm In-Toeing with Out-toeing
- Level of abnormality may be apparent by gait
- Step 2: Evaluate hip rotation
- See Hip Rotation Evaluation in Children
- Limited lateral hip rotation (less than -10 to 20)
- Medial Femoral Torsion
- Step 3: Evaluate Thigh to Foot Angle
- Negative angle suggests Medial Tibial Torsion
- Step 4: Evaluate for foot deformity
- Curved foot suggests Metatarsus Adductus
- Step 5: Evaluate for toe deformity
- Great toe abducted suggests searching toe
- References
- Schmale (2003) AAFP Board Review, Seattle