Intoeing Gait

Intoeing Gait

1. Hip - Anteversion

   • Signs
     • When standing, patella points inwards when feet face forwards
     • Compensatory external rotation
   • Testing
     • Hip rotation
       • Internal
         • Normal: 20-60*
         • Anteversion: >70*
       • External
         • Normal: 30--60*
         • Anteversion: <20*
   • Treatment
     • SOFT TISSUE: Stretching & excercises/activities.
       • AIM: increase external rotation of hip
       • Avoid 'W' position? (not proven)
       • DB Splints?
       • Spontaneous correction

2. Femoral torsion

   • Testing
     • X-ray to see this??
   • Treatment
     • Referral to surgical & MDT
     • May spontaneously resolve
       • If not resolved by 12 - derotational osteotomy
   • The angle formed by the axis through the head and neck of the femur and the transcondylar line of the distal femur
   • Normal values
     • Birth: 30* Internal
     • Adult: 10* internal
     • If the angle of torsion is greater than normal (or greater than 10* internal) this would indicate a less than norm al developmental torsional change, clinically this may be a cause of intoeing

3. Foot/metatarsals

   • Pathology
     • Medial subluxation of tarsometatarsal joints
     • With adduction & inversion of all 5 metatarsals
     • Rearfoot in neutral/varus
   • Classification: Bleck
   • Treatment
     • 90% resolve spontaneouslyy
     • If rigid refer for surgical correction
     • Flexible = serial casting
     • 3-5 years old -abductor hallucis release
     • 8+ multiple metatarsal osteotomies
     • Medial column lengthening & lateral shortening

4. Tibial Torsion

   • A transverse plane rotation of the distal aspect of the tibia relative to the proximal
   • Testing
     • Clinically - measure malleolur position: bisection of the lateral malleoli distally to the bisection of the tibia proximal. Clinically measure the angle formed by the bisection of the medial and lateral malleoli with respect to the frontal plane
   • Treatment
     • Monitor & refer on to surgical team
     • May spontaneously resolve
   • Normal values:
     • Birth: 0*
     • Adult: 18-23* external
   • Examination
     • Thigh - foot angle
       • Normal: 20* external rotation bisection line should be in line with buttoch <10* tibial torsion

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