Secondary to intrauterine positioning Demonstrated by having the child sit with the legs over the side of a table and noticing the positions of the medial and lateral malleoli. No therapy necessary and will resolve spontaneously. Increased internal rotation of hip joint, sometimes to 90 degrees, when the child lies supine. Also increased external rotation. More common in females Often associated with generalized ligamentous laxity demonstrated by hyper abduction of the thumb and hyper mobile pes planus.
Treatment is parental education and reassurance and no specific therapy necessary.
Improves usually by puberty. Exaggeration or assymmetry should raise suspicion of some underlying disorder and evaluation may be necessary. Most common pathologcal conditions associated are rickets and Blount's disease. Reference Mankin, Keith. and Zimbier, Seymour. What's normal and what's not Contemporary Pediatrics.