Peds

In-Toeing

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In-Toeing, Toeing-In, Intoeing, Pigeon-Toed

  • General
  1. Intoeing encases several underlying leg abnormalities
  2. Intoeing may occur at any level down leg kinetic chain
    1. Hip: Medial Femoral Torsion (Femoral Anteversion)
    2. Leg: Medial Tibial Torsion (Internal Tibial Torsion)
    3. Foot: Metatarsus Adductus
  3. Intoeing causes by age (most common causes)
    1. Infant: Metatarsus Adductus
    2. Toddler: Internal Tibial Torsion
    3. Child: Femoral Anteversion (usually bilateral)
  • Approach
  1. Step 1: Evaluate gait and rotational profile (Torsional Profile)
    1. See Foot Progression Angle (Gait Rotational Angle)
    2. Confirm In-Toeing with Out-toeing
    3. Level of abnormality may be apparent by gait
  2. Step 2: Evaluate hip rotation
    1. See Hip Rotation Evaluation in Children
    2. Limited lateral hip rotation (less than -10 to 20)
      1. Medial Femoral Torsion
  3. Step 3: Evaluate Thigh to Foot Angle
    1. Negative angle suggests Medial Tibial Torsion
  4. Step 4: Evaluate for foot deformity
    1. Curved foot suggests Metatarsus Adductus
  5. Step 5: Evaluate for toe deformity
    1. Great toe abducted suggests searching toe
  • References
  1. Schmale (2003) AAFP Board Review, Seattle
  2. Rerucha (2017) Am Fam Physician 96(4): 226-33 [PubMed]