Intoeing Referrals Fact Sheet

This is something I put together for the centre.
They get a lot of referrals for in-toeing which is a
normal part of development.
However, below outlines when you should refer.
Enjoy :)

In-toeing Referrals

The primary health care practitioner such as a GP or nurse can monitor the rotational variations of most children as they grow. Most children who are referred beyond primary care to either an orthopedic surgeon or a physiotherapist for in-toeing are discharged after their first visit. The following are guidelines to assist primary care providers in knowing when to refer a client with an in-toeing posture or gait to an orthopedic surgeon, physiotherapist or pediatric neurologist.

Refer to an orthopedic surgeon if you observe:

●  Metatarsus adductus beyond 2 to 3 months of age

 ○    Metatarsus adductus is a foot deformity seen at birth where the bones inthe front half of the foot bend in toward the body. If the foot can be passively moved into a neutral position it will usually correct itself within the first 2-3 months; refer if it does not correct. If the foot is unable to be passively moved into a neutral position this is known as rigid metatarsus adductus, which requires an immediate referral.

●  In-toeing that does not follow the normal progression

 ○   Children will start to in-toe when they begin to walk and should be straightening out by 8 to 10 years of age. At puberty the child should be slightly out-toeing. Refer if the in-toeing continues to progress after 5 or 6 years of age.

●  Children older than 8 years with tibial torsion (turning of the tibia so that the knee caps face forward, but the toes point inward) that limits their activity level or is cosmetically unacceptable.

●  Children older than 11 years with femoral anteversion (the head and neck of the femur point inwards causing the thigh to rotate inwards) that limits their activity level or is cosmetically unacceptable.

Refer to a physiotherapist or pediatric neurologist if:

●  Child presents with unilateral or asymmetrical in-toeing in addition to clinical findings suggesting a possible neurological disorder such as cerebral palsy or developmental dysplasia of the hip (DDH). DDH is dislocation of the hip joint present at birth. Signs of DDH include clicks, pops or clunks when the hip is moved passively.

●  A unilateral limp is present while walking or running

●  Child complains of pain in the hip or knee joint

●  Difficulty participating in functional age appropriate activities

●  Child trips more than peers