Torsion--treatment indications.

Rotational problems, when outside the normal range, are referred to as torsional deformity. These deformities are relatively common in infancy and childhood, generally resolve spontaneously with growth, and rarely persist into adult life. There are few situations in which treatment is necessary. (1) Rigid metatarsus adductus that does not resolve during the first six months should be corrected by casting. The long leg cast is most effective, as it controls the rotation of the tibia. With the tibia stabilized, the foot can be laterally rotated and abducted, which usually allows correction using one or two casts. (2) Persistent, severe tibial medial or lateral torsion after the age of eight years may be corrected by a supramalleolar tibial rotational osteotomy. This is indicated for medial torsion beyond 15 degrees and for lateral torsion beyond 30 degrees. Fixation is provided by crossed, smooth pins and a long leg cast. Compartment syndromes and peroneal nerve injury are avoided by the distal correction. (3) Persistent, severe femoral antetorsion of more than 50 degrees after the age of eight years may justify correction. For operative correction, medial rotation should exceed 85 degrees and lateral rotation should be less than 10 degrees. The osteotomy for correction is fixed by threaded Steinmann pins cut off below the skin and supplemented with a spica cast.