II. Definition
- Tibia internally rotated with toe pointing inward
III. Epidemiology
- Common pediatric leg rotation variant
- Most common cause of In-Toeing (typically presenting in toddlers)
IV. Physiology: Mean tibial torsion
- Adult 15-20 degrees
- Newborn 5 degrees
V. Signs
- Observation of child walking
- Knee caps point forward
- Femur external
- Tibial internal rotation cancels femur rotation
- Foot points inward (due to tibial rotation)
- Internally rotated thigh foot angle
- Negative Foot Progression Angle
- Knee caps point forward
- Assess Thigh-Foot Angle
- Assess for Tibial Rotation in Children
VI. Course
- Spontaneous resolution in 95% of children by age 5-8 years old
VII. Management
- Avoid braces, night splints, shoe modifications, Orthotics, serial Casting
- Treat any associated Metatarsus Varus (In-Toeing)
- Surgical indications (rare)
- Children >8 years with Thigh-Foot Angle >15 degrees (>3 SD above mean) AND
- Severe functional or cosmetic abnormality not expected to improve
VIII. Prognosis
- Persistent Internal Tibial Torsion is not associated with significant morbidity, Disability or joint degeneration