Rotational problems of the lower extremity.

Rotational abnormalities in the lower extremities are common in the growing child, but they seldom represent any serious handicap in adult life. When confronted with such a problem, the physician should carefully rule out any underlying pathologic abnormality and should approach the problem in a step-wise fashion. The component parts of the lower extremity should be examined carefully and individually to assess their role in the rotational problem. The usual causes of internal rotation problems, or toeing in, are metatarsus adductus, internal tibial torsion, and femoral anteversion. External rotation problems are infrequent and pose fewer problems. These include calcaneovalgus, external rotation of the tibia, and external rotatory contractures of the lower extremity. The natural history of these conditions favors improvement with time. However, some patients may require conservative treatment, such as stretching and splints. Rarely, a patient may require surgical intervention.