In-Toeing and Out-Toeing Gait

  • James Robb


In-toeing and out-toeing, or inward and outward rotation of the foot with respect to the direction of walking, respectively, are common reasons for parental concerns and referral for a specialist opinion. A normal range of values can be considered to lie within two standard deviations on either side of the mean of the values for a given population (Jacquemier et al. 2008) (Fig. 21.1).


Femoral Anteversion Tibial Torsion Derotation Osteotomy Femoral Torsion Outward Rotation 

Supplementary material

Video 21.1

Caption (MPG 4420 kb)


  1. Berg EE. A reappraisal of metatarsus adductus and skewfoot. J Bone Joint Surg Am. 1986;68(8):1185–96.PubMedGoogle Scholar
  2. Delgado ED, Schoenecker PL, Rich MM, Capelli AM. Treatment of severe torsional malalignment syndrome. J Pediatr Orthop. 1996;16(4):484–8.PubMedCrossRefGoogle Scholar
  3. Jacquemier M, Glard Y, Pomero V, Viehweger E, Jouve JL, Bollini G. Rotational profile of the lower limb in 1319 healthy children. Gait Posture. 2008;28(2):187–93.PubMedCrossRefGoogle Scholar
  4. Rao KN, Joseph B. Value of measurement of hip movements in childhood hip disorders. J Pediatr Orthop. 2001;21:495–501.PubMedGoogle Scholar
  5. Ruwe PA, Gage JR, Ozonoff MB, DeLuca PA. Clinical determination of femoral anteversion. A comparison with established techniques. J Bone Joint Surg Am. 1992;74(6):820–30.PubMedGoogle Scholar
  6. Staheli LT, Corbett M, Wyss C, King H. Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg Am. 1985;67(1):39–47.PubMedGoogle Scholar
  7. Windisch G, Salaberger D, Rosmarin W, Kastner J, Exner GU, Haldi-Brändle V, Anderhuber F. A model for clubfoot based on micro-CT data. J Anat. 2007;210(6):761–6.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer India 2015

Authors and Affiliations

  • James Robb
    • 1
  1. 1.OrthopaedicUniversity of St AndrewsScotlandUK

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