Correspondence (letter to the editor): Tibial Torsion Defects

The authors summarized the information well (1). However, I think they omitted a very important aspect of possibly congenital incorrect posture including the examination: tibial torsion defects.

Most commonly in a tibial torsion defect is an external rotation of the foot and the malleoli relative to the knee and the neutral plane. Those affected often compensate the externally rotated feet („Charlie Chaplin“-like gait) by inward rotation of the entire leg, with subsequent internal rotation of the knee (differential diagnosis in knee pain) and retrotorsion of the hip joint, which may lead to hip pain.

I therefore recommend always checking for tibial torsion defects on examination, in addition to the comparison between right-side and left-side internal rotation in supine and in prone positions as mentioned on p 73 of the article.