Last reviewed: November 2017
Last updated: April  2016

Summary

Definition

History and exam

Key diagnostic factors

  • convex lateral border of the sole of the foot
  • asymmetric hip range of motion

Other diagnostic factors

  • foot progression angle >2 standard deviations outside the mean for age
  • hip medial rotation >2 standard deviations outside the mean for age
  • hip lateral rotation >2 standard deviations outside the mean for age
  • thigh-foot axis >2 standard deviations outside the mean for age
  • transmalleolar axis >2 standard deviations outside the mean for age
  • heel-bisector line
  • sitting in the W position
  • medial-facing patella (squinting or cross-eyed patella)
  • lateral knee thrust

Risk factors

  • neuromuscular disease
  • FHx of rotational problems
  • female sex
  • intrauterine position abnormalities
  • short stature or disproportionate body-limb ratio
  • ligamentous laxity

Diagnostic investigations

1st investigations to order

  • anteroposterior pelvic x-rays
  • cross-table lateral x-ray of knee and hip
  • foot x-rays
Full details

Investigations to consider

  • 3-dimensional imaging
  • CT rotational profile evaluations
Full details

Emerging tests

  • quantitative gait analysis
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Sanjeev Sabharwal

Professor

Division of Pediatric Orthopaedic Surgery

Department of Orthopaedics

Rutgers, The State University of New Jersey

Newark

NJ

Disclosures

SS declares that he has no competing interests.

Dr Sanjeev Sabharwal would like to gratefully acknowledge Dr Tamir Bloom, the previous contributor to this monograph. TB declares that he has no competing interests.

Peer reviewers VIEW ALL

Assistant Professor

Department of Orthopedic Surgery

Seoul National University Bundang Hospital

Seoul National University College of Medicine

Seongnam

South Korea

Disclosures

MSP is an author of a reference cited in this monograph.

Assistant Professor of Orthopaedics

Department of Orthopaedic Surgery

Loma Linda University

Loma Linda

CA

Disclosures

SK declares that he has no competing interests.

Professor

Department of Rehabilitation Medicine

Asan Medical Center

University of Ulsan College of Medicine

Seoul

South Korea

Disclosures

Not disclosed.

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