Robert A. Hoekelman, MD; Maurice J. Chianese, MD
EVALUATION
Pertinent History
The incidence of internal tibial torsion is 12% at birth, gradually diminishing to near 0% at 2 years of age.
During fetal life, the tibia is rotated inward on its longitudinal axis relative to the transverse axes of the knee and ankle joints. At birth, it reaches a neutral position. External tibial torsion develops in most babies shortly after birth and is almost universal by age 2 years, reaching 20 degrees of lateral torsion by the time walking is fully established and 23 degrees by adulthood.
Physical Examination
The degree of internal and external tibial torsion can be determined by observing the relative position of the medial and lateral malleoli while the child is sitting on the edge of a table or chair with legs dangling, the patellae facing forward, and the feet in their relaxed position. The medial malleolus is placed posterior to the lateral malleolus in internal tibial torsion and anterior to it in external torsion.
Imaging
The degree of torsion can be measured exactly either radiographically or with special instruments but is not required in most cases.
Chapter 183: Foot and Leg Problems is a sample topic found in AAP Textbook of Pediatric Care
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AAP Textbook of Pediatric Care
