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- Hip rotation-infants IR=40(10-60), ER=70(45-90)
- 10 year old IR=50(25-60), ER=45(25-65)
- Thigh-foot axis-prone with knee flexed 90 degrees=angle between longitudinal axis of thigh and that of the foot. Infants=5 IR(-30-20), 8y/o=10 external(-5-30)
- Heal-bisector line=line drawn through the mid-line axis of the hindfoot and the footfoot. Should pass through the second web space.
- transmalleolar axis=angle between line through the malleoli and line through femoral condyles. Infants average 4 degrees internal tibial torsion. Adults average 23 (0-40)
- Foot progression angle=angle of foot relative to an imaginary straight line while ambulating. In-toeing=negative angular value, out-toeing=positive value. Value=sum of femoral torsion, tibial torsion, foot contour
In-Toeing Differential Diagnosis
- metatarsus adductus
- excessive internal tibial torsion
- excessive femoral torsion.
- Less common=clubfoot, skewfoot, hip disorder, NM disease
- <1yr=metatarsus adductus +/- tibial torsion
- toddlers=internal tibial torsion
- >3y/o=increased femoral anteversion
Out-Toeing Differential Diagnosis
- ER contracture of the hip(infancy)
- external tibial torsion
- external femoral torsion
- severe pes planovalgus
- Less common=SCFE, hip dysplasia, coax vara
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