The authors must have measured the internal tibial torsion
and femoral anteversion and correlated the same with corrected toe-out angulation using the MWI.
Clubfoot is accompanied by internal tibial torsion
. All the joints in the mid and hind foot can be involved in the pathological process.
The evidence-based discussion is ample--for example, her discussion of "tibial torsion," which includes percentage of turnout that may be attributed to tibial torsion, and problems with excessive external tibial torsion, asymmetrical external tibial torsion, and internal tibial torsion
. Elsewhere, in discussing basic principles of conditioning, the treatment of stretching, strengthening, plyometric training, etc., is sparse, but inclusive in discussion of self-assessment and program development: releasing fascia and myofascial restrictions; working your way up from foot to fingers; focus on psoas major weakness, glute vs.
Since feet and hips are normal, this indicates internal tibial torsion
. After thorough assessment of the lower limb mild internal tibial torsion
on both legs was demonstrated.
Intoeing--more commonly known as "pigeon-toe"--is a very common condition that occurs from birth through late childhood and arises from metatarsus adductus (MA), internal tibial torsion
(ITT) or internal femoral anteversion (IFA).
In a case with 2-year follow-up, Bajuifer and Letts7 reported correction of a clubfoot deformity during early infancy, using six 1-week casts, followed by a Denis Browne brace started at 3 months of age, to maintain the correction and manage the internal tibial torsion
. Dhammi and associates, (8) in another case, that of an 18-month-old infant, after four previous trials of serial casting had failed, a posteromedial soft tissue release was performed with ankle mortise reconstruction to attain a plantigrade foot.
To differentiate bowlegs from internal tibial torsion
, have the child placed supine or sitting with knees in extension.
The in-turned foot in relation to a neutral knee (patella facing directly superiorly in supine patient, anteriorly in the standing patient) is due to metaphyseal internal rotation and if excessive is called internal tibial torsion
[1,2] However, toe-in gait can be seen when femoral anteversion, internal tibial torsion
or metatarsus adductus do not decrease sufficiently.
There was internal tibial torsion
in cases which was significant (>15 deg.) In legs.
Internal tibial torsion
is clinically most apparent between ages 1 and 3 years and then in the great majority of cases spontaneously resolves.
Medial subluxation of the navicular on the head of talus and there can be internal tibial torsion