Intoeing

Candidate:

Good morning. Thank you for the opportunity. When examining a patient with intoeing, I would typically follow a systematic approach, starting with a comprehensive history and then moving on to a detailed physical examination. May I proceed with the examination now?

Candidate:

Thank you. Firstly, I would like to obtain a detailed history from the patient or their parents if the patient is a child. I would inquire about the onset, duration, and progression of the intoeing. It’s important to note if it is present since birth or if it developed later. I would also ask about any associated symptoms such as pain, stiffness, or difficulty walking. Additionally, I would explore any relevant family history of similar conditions.

Candidate:

After gathering the history, I would begin with a visual inspection of the patient’s gait and standing posture. This would allow me to assess for any obvious deformities or asymmetries. I would observe the patient from the front, back, and side, noting any abnormalities in limb alignment, foot posture, or leg length discrepancy.

Candidate:

To further evaluate the underlying causes of intolerance, I would proceed with the following physical examinations:

1. Hip examination: I would assess hip range of motion, checking for limitations in internal and external rotation, abduction, and adduction. I would also look for any signs of hip instability or dislocation.

2. Thigh-foot angle measurement: This involves measuring the angle between the long axis of the thigh and the long axis of the foot with the patient lying supine. A positive angle indicates internal tibial torsion, while a negative angle indicates external tibial torsion.

3. Foot examination: I would carefully examine the patient’s feet for any structural abnormalities such as pes planus or pes cavus. I would also assess for any metatarsus adductus or other foot deformities that could contribute to intoeing.

4. Neurological examination: To rule out any underlying neurological causes, I would perform a thorough neurological assessment, including evaluating muscle strength, sensation, deep tendon reflexes, and gait coordination.

Candidate:

: Certainly. The differential diagnoses for intolerance can include:

1. Metatarsus adductus: This is a common cause of entering infants and young children, characterized by a flexible adduction deformity of the forefoot.

2. Internal tibia torsion: This condition involves inward rotation of the tibia, leading to intoeing. It is typically seen in toddlers and usually resolves spontaneously by the age of 6-8 years.

3. Femoral anteversion: It is characterized by excessive medial rotation of the femoral neck, leading to intoeing. It is commonly seen in children aged 2-8 years and often resolves with growth.

4. Hip dysplasia: Developmental dysplasia of the hip can result in intoeing due to associated acetabular or femoral abnormalities.

Candidate:

Based on the clinical findings and differential diagnoses, I would consider the following investigations:

1. X-rays: Anteroposterior and lateral views of the lower limbs can be obtained to assess bone alignment, including the femur, tibia, and foot. This can help evaluate the degree of rotational deformity and rule out any

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Intoeing

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