Prognosis

Healthy (no comorbidity) patients with in-toeing or out-toeing and rotational profile 2 standard deviations within the mean for their age

Despite the wide variation of rotational profiles in infants and toddlers, the natural history is gradual normalisation by age 5 to 6 years. The vast majority of torsional variations correct with growth because version, soft-tissue pliability, and muscle co-ordination change as walking commences and matures.

Torsional variations do not cause long-term problems to other joints and the spine. There is no evidence suggesting that either medially or laterally rotated limbs increase the risk of falling or impair function.[88] In-toeing while running tends to be more common in sprinters, allowing the toe flexors to more effectively enhance push-off.[89]

Tibial torsion: the normal tibia is laterally rotated 5° at birth and increases to 15° to 20° at skeletal maturity.[90] Medial tibial torsion (MTT) usually corrects 1 to 2 years after physiological bowing resolves. Lateral tibial torsion (LTT) is less common in infancy than MTT but is more likely to persist in later childhood. This may decrease walking agility and speed if severe. LTT does not usually resolve with growth.[79]

Most newborns have external rotation contractures of the hips, thought to be due to intrauterine positioning. This usually resolves during early walking, at which time in-toeing may be noticed, commonly due to MTT. Femoral torsion: femoral anteversion (medial rotation) decreases from about 40° (range: 15° to 50°) to 20° (range: 10° to 35°) by age 10 years.[1][2][3][4][91][92] There is limited evidence linking anteversion in adults with physical performance or hip osteoarthritis.[31][93][94][95][96] Medial femoral torsion (MFT) does not cause foot deformities, and foot deformities do not cause MFT.

Healthy (no comorbidity) patients with in-toeing or out-toeing with rotational profile 2 standard deviations beyond the mean for their age

Most torsional deformities resolve with normal growth and development. A growing body of evidence suggests that residual lower-limb rotational malalignment may be associated with premature osteoarthrosis of the hip, knee, and ankle joints.[41][29][30][31][42][97] Excessive LTT has been associated with progressive equinoplanovalgus foot malalignment, hallux valgus malalignment, and osteochondritis dissecans of the knee.[3][98][99][100]

Torsional malalignment syndrome without cerebral palsy

The natural history is one of progression of symptoms, rarely resolution.[66][101]

Torsional malalignment in children with cerebral palsy

The natural history is one of progression of symptoms, rarely resolution.[102][103][104]

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