Lincoln and Suen review common rotational variations in children — in-toeing, out-toeing, and torticollis — describing the five-component rotational profile examination, age-specific etiologies, natural history, and thresholds for imaging and surgical intervention in children younger than 10 years.
When a parent brings in a toddler who trips, use the child's age to drive your differential before touching the patient — tibial torsion in a 2-year-old and femoral anteversion in a 6-year-old are almost always benign and self-resolving, so the most important intervention is reassuring the family and discouraging braces.
Reserve workup and referral for children whose rotational profile falls more than two standard deviations outside the mean for age, who have progressive deformity, or whose torticollis lacks a clearly tight sternocleidomastoid on exam.
Lincoln and Suen review common rotational variations in children — in-toeing, out-toeing, and torticollis — describing the five-component rotational profile examination, age-specific etiologies, natural history, and thresholds for imaging and surgical intervention in children younger than 10 years.
When a parent brings in a toddler who trips, use the child's age to drive your differential before touching the patient — tibial torsion in a 2-year-old and femoral anteversion in a 6-year-old are almost always benign and self-resolving, so the most important intervention is reassuring the family and discouraging braces.
Reserve workup and referral for children whose rotational profile falls more than two standard deviations outside the mean for age, who have progressive deformity, or whose torticollis lacks a clearly tight sternocleidomastoid on exam.