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Internal Tibial Torsion

more about Internal Tibial Torsion


  • In this condition, the tibia (the main bone in the lower leg) has rotated slightly medially (inward, toward the direction of the belt buckle), and is now fixed in this position.  The foot is now also rotated slightly inward because, of course, it is attached to the tibia.  Usually, both tibias are affected.
  • The condition is usually noticed after the child starts to walk, because the associated toe-in is noticed.  This is the commonest cause of toe-in.  The child might trip a lot while walking.
  • Internal tibial torsion (IT torsion) could be confused with other causes of toe-in, but closely looking at the tibia-ankle-foot unit will likely show if this whole unit is rotated slightly inward, starting at the knee.

  • Toe-in while walking
  • The condition does not cause pain.

  • In the uterus, the fetus is in a compact position, with the lower extremities folded up against the body.  The legs fit into this compact position by an inward rotation of the tibias.  If this rotation remains the same in infancy, the child will have internal tibial torsion.
  • Normally, this twisted position unwinds in infancy, before the child learns to walk.  If the rotation does not unwind, there will be in-toeing when the child walks, due to internal tibial torsion.

  • Physical examination by the physician shows that the tibia-ankle-foot unit is slightly rotated inward, and that the rotation is occurring where the tibia joins the knee.

  • This does not seem to run in families, but the firstborn child may be more likely to have this condition.

  • Most physicians agree that no treatment is needed for the ordinary case, and that the condition corrects itself, usually by 10 years of age as the child grows.  This should be discussed with your physician to make sure the condition is actually IT torsion.
  • Watchful waiting is the treatment most physicians recommend, unless the condition is severe.  Most physicians do not recommend splints or special shoes for IT torsion.
  • If the condition is especially severe, an operation might be done to correct the rotation of the tibia at the knee.

  • None known

  • Ask your physician to evaluate the child by a physical examination if the child has toe-in while walking.  If the physician finds IT torsion, it is likely that reassurance will be given.  Once in a while, toe-in is related to mild neurological problems such as mild Cerebral Palsy, and your physician can check for this with a neurological examination at the same time that the physical examination is being done.

  • In Femoral Anteversion, a different condition, the femur (thighbone) is the bone that is rotated slightly inward, carrying the attached tibia-ankle-unit with it, and causing toe-in.
  • In Metatarsus Adductus, a different condition, the front of the foot (near the toes), especially the 1st metatarsal bone attached to the great toe, is the bone that is angled slightly inward toward the midline, causing toe-in, but the back part of the foot is facing straight ahead.




more about Internal Tibial Torsion


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