Challenge of the Week / Pediatrics / 05.07.2021

A 3-year-old boy has intoeing and trips frequently while walking. He tends to sleep in a fetal position on his stomach. His hip internal rotation is 45° and external rotation is 45°. The thigh-foot angle is minus 20° (inwards) and the heel bisector line crosses at the 2nd toe. Which of the following is most likely the cause of his intoeing?
    • Femoral anteversion
    • Internal hip rotation greater than external rotation or a palpated greater trochanteric angle of >15° would indicate this.
    • Internal tibial torsion
    • The thigh-foot angle confirms the deformity to be in the tibia. A bimalleolar axis would also confirm this.
    • Metatarsus adductus
    • The heel bisector going through the lesser rays lateral to the 2nd toe would indicate this.
    • External tibial torsion
    • A positive thigh-foot angle or bimalleolar angle of >15° or 25°, respectively, would indicate this.


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