- Discussion:
- medial rotation of the tibia at the knee causes an intoeing gait;
- it is measured by the angular difference between transmalleolar axis & bicondylar axis of knee;
- may result in part to excessive medial ligamentous tightness;
- it is associated with
metatarsus adductus in about one-third;
- infant exhibits in-toeing and may trip and appear clumsy;
- usually improves with growth;
-
incidence:
- it is the most common cause of intoeing;
- usually seen during the second year of life;
- medial tibial torsion is most apparent when infants first begin to walk,
- it affects both sexes equally
- condition is bilateral in about two-thirds of affected infants (left side affected more than the right);
-
differential diagnosis of intoeing:
-
metatarsus adductus
-
tibial torsion
-
femoral anteversion
-
cerebral palsy can be an early cause of tibial intoeing;
- Exam:
- foot progression angle:
- a rough measurement which is obtained during gait by observing the angle of the foot off of
the line of progression;
- note that severe foot deformities (club foot) which interfere with the usual measurement;
- normal values: range from about 6-10 deg of external rotation;
- thigh foot angle:
- measured with the child in the prone position and knee flexed 90 deg, by observing the
angle of the foot and the thigh;
- thigh foot angle can upto - 5 deg (internal) in infants, but in young children the normal values is about 15 deg;
- besides internal tibial torsion,
metatarsus adductus will decrease FPA;
- unilateral medial tibial torsion is seen twice as often on left side as on the right side;
- feet are medially rotated, while patella remains in neutral position;
- Non Op Treatment:
- Denis Brown splint can be used if symptoms persist, but its efficacy is questionable;
- Operative Treatment:
- correction is seldom necessary except in severe cases, which are adressed with a supramalleolar osteotomy;
- references:
- Medial femoral torsion: experience with operative treatment.
LT Staheli et al.
CORR. Vol 146. 1980. p 222.
-
Tibial rotational osteotomy for idiopathic torsion. A comparison of the proximal and distal osteotomy levels.
Tibial torsion in patients with medial-type osteoarthrotic knees.
Lower-extremity rotational problems in children. Normal values to guide management.
Tibial torsion: a method of assessment and a survey of normal children.
Staheli LT.
CORR. Vol 86. 1972. p 183.
- Misc:
- lateral tibial torsion is usually initially seen during late childhood
or adolescence; sometimes it is first detected when adolescent is
evaluated for patellofemoral pain;
- it is often unilateral, and it is more common on the right side;
