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J Am Acad Orthop Surg, Vol 11, No 5, September/October 2003, 312-320.
© 2003 the American Academy of Orthopaedic Surgeons
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Common Rotational Variations in Children

Todd L. Lincoln, MD and Patrick W. Suen, MD

Dr. Lincoln is Assistant Professor, Department of Orthopaedic Surgery, Stanford University Medical Center, Lucile Salter Packard Children’s Hospital, Palo Alto, CA. Dr. Suen is in private practice at Kaiser Permanente, Oakland, CA.

Most rotational variations in young children, such as in-toeing, out-toeing, and torticollis, are benign and resolve spontaneously. Understanding the normal variations in otherwise healthy children is vital to identifying true structural abnormalities that require intervention. A deliberate assessment of the rotational profile is necessary when evaluating children who in-toe or out-toe. In-toeing is usually attributable to metatarsus adductus in the infant, internal tibial torsion in the toddler, and femoral anteversion in children younger than 10 years. Out-toeing patterns largely result from external rotation hip contracture, external tibial torsion, and external femoral torsion. Although congenital muscular torticollis is the most common explanation for the atypical head posture in children, more serious disorders, including osseous malformations, inflammation, and neurogenic disorders, should be excluded.




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[Abstract] [Full Text] [PDF]


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