Internal Tibial Torsion (Right)

(2)  Internal Tibial Torsion

Internal structural twist (torsion) of the tibia is the most common cause of Pigeon-Toeing in toddlers.

  • As the child begins to walk, the tibial torsion significantly reduces within 6 to 12 months of independent walking.
  • A small percentage of children will continue to have significant tibial torsion.

Femur axis:   Line along length of femur
Foot axis:       Line from heel through                               third web space

Adducted (Pigeon-Toed) Gait

Structural Variance in the Leg (Tibia)

Interpretation:  Normal Values

  • Age 1: -27 to +20 degrees (mean 0 degrees)
  • Age 3: -15 to +25 degrees (mean 7 degrees)
  • Age 5: -5 to +30 degrees (mean 12 degrees)
  • Age 7: 0 to +30 degrees (mean 18 degrees)
  • Age 9: 3 to +33 degrees (mean 20 degrees)

Thigh Foot Angle  - Patient placed in prone position, with knees bent. 

  • Right - normal external tibial rotation of ten degrees 
  • Left - abnormal internal tibial rotation of 25 degrees