Deformities and angular variations of the lower extremities are one of the most common reasons for referral to pediatric orthopedics, with in-toeing seen mostly in infants and young children. Also known as “pigeon-toeing,” this is caused by a rotational variation anywhere in the lower extremity that causes the foot to point inward.
In coming to understand variational pathologies of the lower limb, it is important to be familiar with the normal growth and development of children’s lower extremities. Neonates are born with about 40 degrees of femoral anteversion or forward rotation of the femoral neck. This increased internal rotation of the hip decreases over time. By about 10 years old, the degree of anteversion decreases by about half. Any deviation from the expected course of limb development and rotation should be recognized and differentiated from the persistence of early angulation, to pathologies preventing normal rotation.
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