title: In-Toeing Is Often a Primary Care Orthopedic Condition.
abstract: To evaluate in-toeing consults to a pediatric orthopedic clinic to determine the proportion that could be managed by a primary care physician.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Orthopaedics, Penn State College of Medicine, Hershey, PA.
authors.forename: John A
authors.initials: JA
authors.lastname: Sielatycki
authors.affiliation: Department of Orthopaedics, Penn State College of Medicine, Hershey, PA. Electronic address: whennrikus@hmc.psu.edu.
authors.forename: William L
authors.initials: WL
authors.lastname: Hennrikus
authors.affiliation: Department of Orthopaedics, Penn State College of Medicine, Hershey, PA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Swenson
authors.affiliation: Department of Orthopaedics, Penn State College of Medicine, Hershey, PA.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Fanelli
authors.affiliation: Department of Orthopaedics, Penn State College of Medicine, Hershey, PA.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Reighard
authors.affiliation: Department of Orthopaedics, Penn State College of Medicine, Hershey, PA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Hamp
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D000070592:Metatarsus Varus / Q000628:therapy*; D009985:Orthopedics; D010372:Pediatrics; D011320:Primary Health Care; D011446:Prospective Studies; D012042:Registries
keywords: angular deformity; femoral anteversion; internal tibial torsion; metatarsus adductus; musculoskeletal education; referral; rotational deformity