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Rotational Variations in Children

  • Hip rotation-infants IR=40(10-60), ER=70(45-90)
  • 10 year old IR=50(25-60), ER=45(25-65)
  • Thigh-foot axis-prone with knee flexed 90 degrees=angle between longitudinal axis of thigh and that of the foot.  Infants=5 IR(-30-20), 8y/o=10 external(-5-30)
  • Heal-bisector line=line drawn through the mid-line axis of the hindfoot and the footfoot.  Should pass through the second web space.
  • transmalleolar axis=angle between line through the malleoli and line through femoral condyles.  Infants average 4 degrees internal tibial torsion.  Adults average 23 (0-40)
  • Foot progression angle=angle of foot relative to an imaginary straight line while ambulating.  In-toeing=negative angular value, out-toeing=positive value.  Value=sum of femoral torsion, tibial torsion, foot contour

In-Toeing Differential Diagnosis

  • metatarsus adductus
  • excessive internal tibial torsion
  • excessive femoral torsion.
  • Less common=clubfoot, skewfoot, hip disorder, NM disease
  • <1yr=metatarsus adductus +/- tibial torsion
  • toddlers=internal tibial torsion
  • >3y/o=increased femoral anteversion

Out-Toeing Differential Diagnosis

  • ER contracture of the hip(infancy)
  • external tibial torsion
  • external femoral torsion
  • severe pes planovalgus
  • Less common=SCFE, hip dysplasia, coax vara


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