In-toeing and out-toeing in children.

Torsional problems are common in children but rare in adults. Most resolve spontaneously; however, some require treatment. The primary care physician should be able to determine the cause of the deformity. A general screening examination is performed to rule out hip dysplasia and other skeletal defects, estimate in-toeing or out-toeing, determine hip rotation as a measure of femoral torsion, and observe the shape of the foot. These observations determine the torsional profile. The site and severity of the deformity can be ascertained from the information on the torsional profile. The common problems encountered in clinical practice include metatarsus adductus, out-toeing in early infancy, medial tibial torsion, and medial femoral torsion. The persisting or severe forms of these torsional deformities are probably genetically determined. Shoe modifications are useless; bracing is ineffective. Surgical rotational osteotomies are effective, but risky, and indicated only for severe, persisting deformities.