In-Toeing Is Often a Primary Care Orthopedic Condition

John A. Sielatycki, William L. Hennrikus, Richard D. Swenson, Matthew G. Fanelli, Cynthia J. Reighard, Jane A. Hamp

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)297-301
Number of pages5
JournalJournal of Pediatrics
StatePublished - 2016

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health


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