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- Intoeing, as a presumptive diagnosis, results in numerous orthopedic consultations.
- Causes of intoeing are most frequently one or more of the following: metatarsus adductus, internal tibial torsion, and femoral anteversion.
- Version: normal variation in axial alignment
- Torsion: any variation beyond two standard deviations of normal
- Clear explanation of the difference between physiologic variations and pathologic anatomy will allow the treating physician to effectively manage expectations.
Very common; one the most common reasons for a “well child” to visit an orthopedist
No strong evidence of familial links
- Most are self-limiting issues but when paired together, can cause significant issues.
- Excessive femoral anteversion and external tibial torsion can result in the so-called “miserable malalignment,” known to cause significant patellofemoral issues.
- In utero, fetuses are subjected to forces that mold feet and tibiae into adductus and internal torsion, respectively.
- Most children are born with a relatively increased femoral anteversion (approximately 45 degrees).
- Tends to resolve and “unwind” as the child develops
- Usually resolves by age 8–10 years to the normal adult anteversion of 10–20 degrees
Commonly Associated Conditions
May be more common in first-born children (especially metatarsus adductus) as part of the “packaging disorders” such as developmental dysplasia of the hip and torticollis