NHx
In-toeing is normal up til 8 - 10 years
- combination ITT / PFA
- anteversion decreases, ETT increases
Causes Intoeing
PFA
- usually symmetrical
- unilateral consider CP
ITT
- usually asymmetrical
Foot
- metatarsus adductus
- CTEV
- metatarsus primus varus
- skewfoot
Causes out-toeing
ETT
- usually unilateral
- consider NM cause i.e. CP, SB
SUFE
Examination
Staheli's Torsional Profile
Look
Squinting patella
- rotation above patella, in femur
Foot Progression angle
- Us 10° out (0°-30°)
Prone
Foot
- curved lateral border
- heel bisector should pass through second MT
Thigh- Foot Angle TFA
- knees flexed
- Reconstruct foot
- Usually 15° (0°-30°) ER
Transmalleolar Axis (TMA)
- knees flexed
- Usually 0 - 30° ER
Hip Internal Rotation
- Usually < 65°
- > 70° = FAV
Gage's trochanteric angle
- GT most prominent laterally
- angle of tibia from verticle
Hip External Rotation
- Usually 40° (20-60°)
- Greater in young child
- Note IR + ER should = 90°