Intoeing--fact, fiction and opinion.

Intoeing in children is a common cause of parental concern. A normal neurologic examination and normal height and weight for age help the physician exclude most associated skeletal dysplasias, and neuromuscular or metabolic diseases. Three causes of intoeing affect otherwise normal newborns and infants. Metatarsus adductus is the diagnosis if a "C" shaped curve, rather than a straight border, is present on the lateral aspect of the foot. About 90 percent of cases resolve by one year of age. Internal tibial torsion, although a normal finding in the newborn, is usually a matter of concern at walking age. When the child is walking or standing, the patella can be seen to point forward, with the foot pointing inward. Children with excessive femoral anteversion, the most common cause of intoeing, walk or stand with both patella and feet pointing inward. Nonsurgical treatment, with the exception of casting in children with metatarsus adductus, has not been shown to be effective. Osteotomy, the only effective treatment for rotational abnormalities of the femur and tibia, has high complication rates and should not be considered until the patient is eight to 10 years of age. Since disability from intoeing is extremely rare and most cases resolve spontaneously, observation and parental education are important from the time of diagnosis.