II. Definitions
- Internal Tibial Torsion
- Tibia internally rotated with toe pointing inward
III. Epidemiology
- Common pediatric leg rotation variant
- Most common cause of In-Toeing in age 1-3 years (typically presenting in toddlers)
- Newborns have mean tibial internal rotation of 5 degrees
IV. Pathophysiology
- Internal Tibial Torsion may be related to in utero positioning
V. Signs
- Bilateral in two thirds of cases
- 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
- See Tibial Rotation in Children
- Abnormal if tibial internal rotation >10 degrees (referral indication at age >8 years)
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 (other cause of 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
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Related Studies
| Concepts | Finding (T033) |
| SnomedCT | 299228008 |
| Dutch | inwendige tibiatorsie |
| French | Torsion du tibia interne |
| German | interne tibiale Torsion |
| Italian | Torsione tibiale interna |
| Portuguese | Torção tibial interna |
| Spanish | Torsión tibial interna, torsión interna de tibia, torsión tibial interna (hallazgo), torsión tibial interna |
| Japanese | 脛骨内捻転, ｹｲｺﾂﾅｲﾈﾝﾃﾝ |
| Czech | Interní tibiální torze |
| Hungarian | Tibialis belső torsio |
| English | Internal tibial torsion, Internal tibial torsion (finding) |
