Spectrum of diagnosis and disposition of patients referred to a pediatric orthopaedic center for a diagnosis of intoeing

Shawne Faulks, Kaitlyn Brown, John G. Birch

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Orthopaedic surgeons frequently evaluate otherwise healthy children for concern of intoed gait. Intoeing in otherwise healthy young children due to metatarsus adductus, internal tibial torsion, and increased femoral anteversion do not typically require orthopaedic treatment. This study reviewed the actual diagnosis, management, and disposition of patients referred to a pediatric orthopaedic specialty hospital for a diagnosis of intoeing; the efficacy of an Advanced Practice Provider (APP) assessment program to screen and triage patients with a primary complaint of intoeing; and parental satisfaction with that program. Methods: We established an "Intoeing Clinic" conducted by APPs to conduct initial evaluations of patients referred for a diagnosis of intoeing meeting-specific criteria, including (1) a referring provider's diagnosis of "intoeing"; (2) the patient was under the age of 9 years; and (3) there was no suggestion of comorbidity in the information provided by the referring provider to imply a diagnosis other than "benign" intoeing. Under pediatric orthopaedic surgeon "on-call" supervision, APPs were authorized to perform clinical assessments supplemented by radiographs and laboratory investigations as deemed necessary. We performed an Institutional Review Board-approved, retrospective medical record review of all patients appointed to our Intoeing Clinic over a 30-month period (March 2010 to September 2013). Results: About 95% of 926 patients appointed to APP Intoeing Clinic were confirmed to have a diagnosis of "benign" intoeing or a similar "benign" diagnosis; 5% of these patients requested a reevaluation for the same concern. Approximately 5% were determined to have a nonbenign diagnosis, either known to the family/provider, but not conveyed at the time of referral (4%), or identified at our institution (1%). Two patients (0.2%) were determined at follow-up examination to have a neurological abnormality at the subsequent examination. Conclusions: An "Intoeing Clinic" staffed by experienced Advanced Pediatric Practitioners or equivalent, with appropriate orthopaedic surgeon availability for consultation can be an effective and efficient method of evaluating patients referred for a diagnosis of "intoeing."

Original languageEnglish (US)
Pages (from-to)e432-e435
JournalJournal of Pediatric Orthopaedics
Volume37
Issue number7
DOIs
StatePublished - 2017

Keywords

  • Advanced Practice Providers
  • intoed gait
  • intoeing
  • screening clinic

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

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