Torsional Deformity: A Review Article

Rotational variations of the lower extremities, including in-toeing and out-toeing, are common in children and usually represent normal developmental differences rather than pathological conditions. In-toeing is most frequently caused by metatarsus adductus in infants, internal tibial torsion in toddlers, and persistent femoral anteversion in older children, while out-toeing may result from femoral retroversion, external tibial torsion, severe pronation, or torsional malalignment. Diagnosis relies on history and physical examination, including assessment of Foot-Progression Angle (FPA), hip rotation, tibial torsion, and the transmalleolar axis, with imaging reserved for atypical or severe cases. Management is predominantly non-surgical, focusing on observation and physiotherapy, with most children improving spontaneously over time. Surgical intervention, such as rotational osteotomy, is indicated in absolute cases with severe functional or cosmetic impairment. Understanding the natural history, diagnostic evaluation, and treatment options is essential for guiding clinical management and counseling families.