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At what age should apparent be worried about their child intoning?

 

In my opinion, you should never be worried unless the child has a co-existing neuromuscular disorder. In the vast majority of cases, the in-toeing resolves. How often do you see adults with an in-toed gait? Studies have shown that if adults are mildly in-toed, they make very good sprinters. How often do you see an adult with a fairly in-toed gait that does not have a co-existing neuromuscular disorder?

Do a through biomechanical exam to see what you are dealing with and monitor.
Internal femoral torsion or internal femoral position? In the former, the femoral head is more anterior so there is greater internal rotation. As the angle of femoral head and neck to the transcondylar line decreases, there will be more external rotation. This usually happens by the age 15 or so. The patella will be medially displaced if hip is involved as the patella is moving with the femur.

Are the medial hamstrings tight compared to the lateral hamstrings?

Check malleolar position. Is there lack of external rotation of the tibia causing an adducted gait? I don't like gait plates but they probably function better for Internal femoral torsion than lack of external rotation of the tibia.

Is their metatarsus adductus? Hopefully not as this should have been treated very early on while the deformity was still flexible.

If there is no biomechanical reason why the child walks adducted, it may be simply out of habit and the child has to be encouraged to walk straight. Mainly, the parents need to be told that there is nothing to be concerned about and you will monitor the child annually.

Steven

 

Thanks for your reply. Has reinforced my thoughts