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]