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Internal Tibial Torsion
Aka: Internal Tibial Torsion, Medial Tibial Torsion
- Definition
- Tibia internally rotated with toe pointing inward
- Epidemiology
- Common pediatric leg rotation variant
- Most common cause of In-Toeing (typically presenting in toddlers)
- Physiology: Mean tibial torsion
- Adult 15-20 degrees
- Newborn 5 degrees
- 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
- Assess Thigh-Foot Angle
- Assess for Tibial Rotation in Children
- Course
- Spontaneous resolution in 95% of children by age 5-8 years old
- 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
- Prognosis
- Persistent Internal Tibial Torsion is not associated with significant morbidity, Disability or joint degeneration
- References
- Rerucha (2017) Am Fam Physician 96(4): 226-33 [PubMed]