TY - JOUR
T1 - In-Toeing Is Often a Primary Care Orthopedic Condition
AU - Sielatycki, John A.
AU - Hennrikus, William L.
AU - Swenson, Richard D.
AU - Fanelli, Matthew G.
AU - Reighard, Cynthia J.
AU - Hamp, Jane A.
N1 - Publisher Copyright:
© 2016
PY - 2016
Y1 - 2016
N2 - Objective To evaluate in-toeing consults to a pediatric orthopedic clinic to determine the proportion that could be managed by a primary care physician. Study design A prospective registry was created for 143 consecutive children referred to a pediatric orthopedic clinic for “in-toeing.” Each patient underwent a careful history and physical examination, which included a rotational profile. We recorded the final diagnosis, treatment offered, follow-up visit results, and the source of the referral. Results After pediatric orthopedic evaluation, 85% of patients had a confirmed diagnosis of in-toeing, and 15% had a different final diagnosis. Seventy-four percent of patients had 1 consultation visit, 18% had 2, and 8% had >2 visits. None of the referred patients was a candidate for treatment by casting or surgery. Conclusion In most cases, in-toeing is a normal variation of development that can be managed by counseling and observation by the primary care physician alone. Rare cases of severe in-toeing >2 standard deviations from the mean should likely still prompt referral to a pediatric orthopedic surgeon for potential intervention.
AB - Objective To evaluate in-toeing consults to a pediatric orthopedic clinic to determine the proportion that could be managed by a primary care physician. Study design A prospective registry was created for 143 consecutive children referred to a pediatric orthopedic clinic for “in-toeing.” Each patient underwent a careful history and physical examination, which included a rotational profile. We recorded the final diagnosis, treatment offered, follow-up visit results, and the source of the referral. Results After pediatric orthopedic evaluation, 85% of patients had a confirmed diagnosis of in-toeing, and 15% had a different final diagnosis. Seventy-four percent of patients had 1 consultation visit, 18% had 2, and 8% had >2 visits. None of the referred patients was a candidate for treatment by casting or surgery. Conclusion In most cases, in-toeing is a normal variation of development that can be managed by counseling and observation by the primary care physician alone. Rare cases of severe in-toeing >2 standard deviations from the mean should likely still prompt referral to a pediatric orthopedic surgeon for potential intervention.
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U2 - 10.1016/j.jpeds.2016.06.022
DO - 10.1016/j.jpeds.2016.06.022
M3 - Article
C2 - 27470689
AN - SCOPUS:84979697567
SN - 0022-3476
VL - 177
SP - 297
EP - 301
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -