Definition
Angular difference between transcondylar axis of knee & transmalleolar axis
Aetiology
Though to be a packaging disorder
Epidemiology
Number 1 cause of intoeing in 2 year odl
- does not occur in preterm infants
10% < 2 years ITT
- 2/3 bilateral
- 1/3 unilateral of these usually left side
NHx
Normal 0 - 30o ER
Most cases of ITT resolve by 2 years of age
- TMA increases 0-5° from age 1 to 2 years
- few resolve > 8 years
- resolution not universal
- positive FHx association with poor prognosis
Associations
Associated with MT Adductus in 1/3
NMD / CP
DDx
NMD
Fracture
Tibia vara
Symptoms
Children tend to trip & appear clumsy
Examination
Patella normal position
- in-toeing
- thigh foot angle < 0o
- TMA < 0o
Management
Non-operative Management
Splints shown not to work
Operative Management
Complication rate of proximal tibial osteotomy very high
Supramalleolar Osteotomy
Indications
1. TMA > 3 SD (< -10° or > 40°)
2. Age 10+ years
3. Severe disability
Technique
- anterolateral approach
- DCP plate