Do children who in-toe need to be referred to an orthopaedic clinic?

Area of Science:

• Paediatric Orthopaedics
• Clinical Audit
• Biomechanical Assessment

Background:

• In-toeing is a common paediatric referral concern.
• Common causes include increased femoral anteversion and internal tibial torsion.
• The necessity and impact of orthopaedic referral require investigation.

Purpose of the Study:

• To investigate the outcomes of children referred for in-toeing to a paediatric orthopaedic department.
• To determine the diagnostic yield and management pathway for these referrals.
• To assess the impact of orthopaedic referral on patient management and outcomes.

Main Methods:

• Retrospective review of 202 patients referred between July 2005 and March 2008.
• Analysis of diagnoses, age at referral, treatment received, and follow-up outcomes.
• Data collected from Royal Hospital for Sick Children, Edinburgh.

Main Results:

• The majority of diagnoses were increased femoral anteversion and internal tibial torsion.
• Median age at referral was 4 years.
• No patients required surgery during the audit period; 86% were discharged after the first visit.
• No significant pathology was identified in 14% of reviewed cases.

Conclusions:

• Referral for in-toeing to paediatric orthopaedics has a low surgical yield.
• Most children are managed conservatively and discharged promptly.
• Referral to the orthopaedic clinic did not significantly alter the management or outcome for these children.