Medial or internal rotation of the foot in the transverse plane during gait.
1. Antetorsion – internal twist in the femur (normally 30 degrees at birth, but should have reduced to 8 – 12 in childhood)
2. Anteversion – positional alteration in the hip joint
3. Internal genicular position
4. Internal tibiofibular position (normally up to 5 degrees external at birth – should be up to 18 degrees by adulthood)
5. Metatarsus adductus
Adducted gait; parental concern; may appear as though ‘knock knees’ are present; fatigue is common; ‘tripping’ is common; a compensatory foot pronation may occur to ‘straighten’ the foot
Most cases of in-toe do not need treatment
Change of sitting or sleeping position – avoid ’W’ sitting position for in-toe problems and use as part of treatment for out-toe problems
Bars or braces – eg Dennis-Browner bar; Ganley splint; Counter Rotation Splint™ allows more freedom for child to move around
Gait plates – designed to encourage in- or out-toe gait – unclear as to efficacy, but may help tripping
Foot orthoses to protect foot from compensatory pronation
Surgical correction – rarely needed; rotational osteotomy of the tibia and/or femur may be used in severe cases.