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I have two paediatric patients; sisters 2 years and 4 years.

Normal birth, no signs of intoeing in parents.

Both sisters have exactly the same problem with intoeing gait; greater FFoot adduction in Right than Left. Both patients have ligamentous laxity and hyperextend at the knee joints. Internal knee rotation - all soft tissue as they can be put into neutral position. Mother has noticed both girls tripping occassionally when running.

Sitting and sleeping with adducted feet - so suggested to mother to try and discourage this (hard though) and to encourage games that promote abducting feet (eg frog hopping and biking with strap on pedals to abduct feet). Footwear suggested - supportive lace up boots (as they were in canvas shoes and ugg boots)

Currently I am adjusting some generic kids orthotics (cheaper for parent) and adding in gait plates.

What else can I do to help these girls? Please help.

Podski:

Sounds like you have most bases covered.

One of the most important things in managing intoeing is to establish the level of the 'twist'. From what you say, since the knee is internally rotated, this would indicate that the level of deformity is somewhere at the femur. Is the intoeing symmetrical or or unilateral?

Assuming your patients are showing symmetrical intoeing, given their ages, one could be pretty sure that they both still have a good deal of lower limb development to go-this means 'untwisting' of the offending femur-all normal development. Indeed, it wouldn't be unusual to see quite alot of 'untwisting' in your patients lower limbs over the next 3-4 years or so.

Think carefully about why you are giving your patients orthoses-may be of limited benefit. If anything gait plates might only be any good to get them through the transient phase of tripping more than their peers - even at that, their use might be limited. Maybe monitoring in addition to your other advice is all that is needed.

__________________
Kind regards

Gavin Wylie
Podiatrist (Paediatrics),
Perth Royal Infirmary,
Perth, UK

Hi Gavin,

Thanks for your help,

The intoeing is symmetrical, however there is greater abduction of the right limb and foot in both girls.