Rotational Deformities of the Lower Limb in Children

Rotational deformities are common lower extremity abnormalities in children. Rotational problemsinclude in-toeing and out-toeing. In-toeing is caused by one of the three types of deformity:metatarsus adductus, internal tibial torsion, and increased femoral anteversion. Out-toeing is lesscommon than intoeing, and its causes are similar but opposite to those of intoeing. These includefemoral retroversion and external tibial torsion. An accurate diagnosis can be made with carefulhistory and physical examination, which includes torsional profile (a four- component composite ofmeasurements of the lower extremities). Charts of normal values and values with two standarddeviations for each component of the torsional profile are available. In most cases, the abnormalityimproves with time. A careful physical examination, explanation of the natural history, and serialmeasurements are usually reassuring to the parents. Treatment is usually conservative. Special shoes,cast, or braces are rarely beneficial and have no proven efficacy. Surgery is reserved for olderchildren with deformity from three to four standard deviations from the normal.