Clinical features of common causes of in-toeing in children

* The heel bisector line is measured with the child prone, the knee flexed, and ankle dorsiflexed so that the plantar surface of the foot is parallel to the ceiling. A visual line is approximated parallel to the heel and extended distally to the toes. Refer to UpToDate content on metatarsus adductus for details.
¶ The thigh-foot angle is measured with the child prone, the knee flexed, and the ankle dorsiflexed so that the plantar surface of the foot is parallel to the ceiling. A visual line is approximated along the long axis of the thigh and a second line along the long axis of the heel. The angle between these two lines is the thigh-foot angle. Refer to UpToDate content on internal tibial torsion for details.
Δ Internal hip rotation is measured with the child prone and the knees flexed. The lower leg is rotated away from the axis of the body. Normal hip rotation varies according to age. Refer to UpToDate content on increased femoral anteversion for details.
◊ The legs flip laterally during the swing phase, when the foot is off the ground.