II. General

  1. Intoeing encases several underlying leg abnormalities
  2. Intoeing may occur at any level down leg kinetic chain
    1. Hip: Medial Femoral Torsion (Femoral Anteversion)
    2. Leg: Medial Tibial Torsion (Internal Tibial Torsion)
    3. Foot: Metatarsus Adductus
  3. Intoeing causes by age (most common causes)
    1. Infant: Metatarsus Adductus
    2. Toddler: Internal Tibial Torsion
    3. Child: Femoral Anteversion (usually bilateral)

III. Approach

  1. Step 1: Evaluate gait and rotational profile (Torsional Profile)
    1. See Foot Progression Angle (Gait Rotational Angle)
    2. Confirm In-Toeing with Out-toeing
    3. Level of abnormality may be apparent by gait
  2. Step 2: Evaluate hip rotation
    1. See Hip Rotation Evaluation in Children
    2. Limited lateral hip rotation (less than -10 to 20)
      1. Medial Femoral Torsion
  3. Step 3: Evaluate Thigh to Foot Angle
    1. Negative angle suggests Medial Tibial Torsion
  4. Step 4: Evaluate for foot deformity
    1. Curved foot suggests Metatarsus Adductus
  5. Step 5: Evaluate for toe deformity
    1. Great toe abducted suggests searching toe

IV. References

  1. Schmale (2003) AAFP Board Review, Seattle
  2. Rerucha (2017) Am Fam Physician 96(4): 226-33 [PubMed]

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Ontology: Toeing-in (C0231791)

Concepts Finding (T033)
SnomedCT 206822004, 269038003, 156858002, 268131002, 77599005, 274148003
English Toeing-in, [D]In-toeing (context-dependent category), [D]In-toeing, in-toeing, pigeon toed, pigeon toes, in toe, intoe, intoeing, to pigeon, Pigeon toed, toe in, Intoing, Intoeing, Toe, overlapping - acquired, Overlapping toe - acquired, [D]In-toeing (situation), In-toeing, Intoe, Pigeon toe, Pigeon toe (finding), Toeing-in (finding), pigeon toe
Dutch O-teen, lopen met naar binnen gedraaide voeten
French Pied cagneux, Démarche en rotation interne
German Einwaertsdrehen der Fuesse beim Gehen, Einwaertsdrehen der Fuesse
Italian Dito del piede a piccione, Andatura da piede varo
Portuguese Pontas dos dedos dos pés para dentro, Rotação interna do pé
Spanish Pie varo, [D]metatarso varo (categoría dependiente del contexto), Rotación interna del pie, Pigeon toe (finding), Pigeon toe, [D]metatarso varo, [D]metatarso varo (situación), metatarso varo (hallazgo), metatarso varo, desviación interna de los dedos de los pies (hallazgo), desviación interna de los dedos de los pies
Japanese 内股, ウチマタ, ウチワ, うちわ
Czech Chůze špičkami vytočenými dovnitř, Addukční noha
Hungarian Galambujj-szerű elváltozás (varus lábujj), Varus ujj