Tests
1st tests to order
anteroposterior pelvic x-rays
Test
Ordered when hip exam is marked by pain or asymmetric range of motion, neuromuscular diseases, or gait abnormality that is not easily explained by rotational profile.
Rules out hip dysplasia, slipped capital femoral epiphysis, avascular necrosis of the femoral head, and hip osteoarthrosis.
However, do not order radiographs for a child <4 months with suspected hip dysplasia or for a child <8 years with simple in-toeing gait, which can be monitored unless there is severe tripping and falling, or asymmetry.[46][61][62]
Result
normal for most torsional deformities
cross-table lateral x-ray of knee and hip
Test
Ordered in a child >8 years of age with a recent change or abnormality in gait, and knee or hip pain.
Rules out hip dysplasia, slipped capital femoral epiphysis, avascular necrosis of the femoral head, hip osteoarthrosis, or Blount disease.
However, do not order radiographs for a child <8 years with simple in-toeing gait, which can be monitored unless there is severe tripping and falling, or asymmetry.[46][61]
Result
normal for most torsional deformities
foot x-rays
Test
Taken in the weight-bearing position.
Helps diagnose clubfoot, skewfoot, congenital vertical talus, and hallux valgus.
Order if any foot deformities are noted on examination or if the feet are painful, swollen, or stiff.
However, do not order radiographs for a child <8 years with simple in-toeing gait, which can be monitored unless there is severe tripping and falling, or asymmetry.[46][61]
Result
normal for most torsional deformities; positive for other causes of intoeing, such as hallux varus, metatarsus adductus, and clubfoot
Tests to consider
3-dimensional imaging
Test
Three-dimensional CT, MRI, EOS™, and ultrasound all accurately and precisely measure torsional alignment.[65][66][67] Primarily reserved for surgical planning and rarely indicated for routine evaluation.[75]
Do not order CT or MRI in children until all appropriate clinical and plain radiographic exams have been completed.[61]
Result
helps to quantify the location and magnitude of each torsional deformity
CT rotational profile evaluations
Test
May be used to measure severe or complex torsional deformities, such as miserable malalignment syndrome, in older children.
Do not order CT in children until all appropriate clinical and plain radiographic exams have been completed.[61]
Result
helps to quantify the location and magnitude of each torsional deformity
Emerging tests
quantitative gait analysis
Test
Provides information on dynamic alignment and range of motion. Primarily reserved for assessing gait abnormalities in neuromuscular conditions (e.g., cerebral palsy) for surgical decision-making.
Result
helps to quantify the location and magnitude of each torsional deformity
Use of this content is subject to our disclaimer