Orthopedics Book


Internal Tibial Torsion

Aka: Internal Tibial Torsion, Medial Tibial Torsion
  1. Definition
    1. Tibia internally rotated with toe pointing inward
  2. Epidemiology
    1. Common pediatric leg rotation variant
    2. Most common cause of In-Toeing (typically presenting in toddlers)
  3. Physiology: Mean tibial torsion
    1. Adult 15-20 degrees
    2. Newborn 5 degrees
  4. Signs
    1. Observation of child walking
      1. Knee caps point forward
        1. Femur external
        2. Tibial internal rotation cancels femur rotation
      2. Foot points inward (due to tibial rotation)
        1. Internally rotated thigh foot angle
        2. Negative Foot Progression Angle
    2. Assess Thigh-Foot Angle
      1. Assess for Tibial Rotation in Children
  5. Course
    1. Spontaneous resolution in 95% of children by age 5-8 years old
  6. Management
    1. Avoid braces, night splints, shoe modifications, Orthotics, serial Casting
    2. Treat any associated Metatarsus Varus (In-Toeing)
    3. Surgical indications (rare)
      1. Children >8 years with Thigh-Foot Angle >15 degrees (>3 SD above mean) AND
      2. Severe functional or cosmetic abnormality not expected to improve
  7. Prognosis
    1. Persistent Internal Tibial Torsion is not associated with significant morbidity, Disability or joint degeneration
  8. References
    1. Rerucha (2017) Am Fam Physician 96(4): 226-33 [PubMed]

Internal tibial torsion (C0575994)

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)
Derived from the NIH UMLS (Unified Medical Language System)

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