In Toeing By. Dr. J. K. Jain

Problem:most of the time this intoeing occur because of increased femoral anteversion but some time they can occur because of spastic tibialis posterior muscle/ internal tibial torsion

Management Protocol: Most of time intoeing occur because of bony torsion and need surgical correction. This problem can not be managed conservatively. Increase femoral anteversion / internal tibial torsion can be managed by derotational osteotomy of respective bone and tibial posterior contracture will be managed by lengthening or partial transfer.

In toeing gait means walking with inward movement of the lower limb during walking. This gait pattern causes frequent falls in children. In cerebral palsy, it occurs mostly because of the torsional problem in the lower limb. This torsional deformity can be at femur, tibia or foot. The most common cause of in toeing is femoral ante torsion (increase in femoral anteversion). It is very important to evaluate the exact site of bony torsion. Most of the time they need bony surgery (Derotational osteotomy ) along with SEMLS. Properly planned Cerebral Palsy Surgery with intensive therapy give good outcome in term of energy efficiency and gait pattern.