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Eric Gordon: Lower Extremity Deformity Planning and Correction in Children

Grand Rounds Video of Eric Gordon at Mass General Hospital, Boston, MALower Extremity Deformity Planning and Correction in Children
Eric Gordon, MD
Professor of Orthopaedic Surgery
St Louis Children’s Hospital,
Washington University, St Louis, MO

Grand Rounds presented on September 20, 2012 at O’Keefe Auditorium, Massachusetts General Hospital, Boston, MA
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In-Toeing Gait In Children

Intervention is often not necessary for children with in-toeing gait. Kids grow out of it.

If you observe people’s feet as they stand or walk, you may notice that their feet generally point straight ahead or perhaps slightly outward. However, many people point their feet inward. This is called in-toeing or pigeon toes.

In-toeing is common in young children, a frequent concern of many parents and a very common referral to our Pediatric Orthopaedic Clinic. In the overwhelming majority of patients, in-toeing corrects itself with time. Treatment is only necessary in a tiny fraction of patients.

“In-toeing does not lead to arthritis or interfere with sports. Toddlers who in-toe do tend to fall more frequently, because unlike adults, toddlers cannot increase the length of their strides, but can only increase the number of steps, which results in clumsiness and tripping,” asserts Dr Brian Grottkau, Chief of Pediatric Orthopaedic Surgery at the Massachusetts General Hospital, and Assistant Professor of Orthopaedic Surgery at Harvard Medical School, Boston, MA.

Causes of In-toeing Gait
The three most common causes of in-toeing in children are twisting of the thigh bone (femoral anteversion), twisting of the shin bone (internal/medial tibial torsion) and curved feet (metatarsus adductus). Your pediatric orthopaedic surgeon will evaluate your child and determine if in-toeing is coming from the hips, legs, or feet.

schematic of different types of In-toeing gait in children
Illustration by Navina Chabria – Thank you
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