Tibial Bowing, Posteromedial (Pediatric)

Synonyms
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INTRODUCTION

Definition

Congenital posteromedial bowing of tibia.

Epidemiology

Associated with leg length discrepancy, calcaneovalgus foot, and tight anterior structures.
  • It is not associated with other anomalies such as neurofibromatosis or with tibial fractures or pseudoarthrosis.

Pathoanatomy

Usually affects the middle and distal thirds of the tibia.

Etiology

Thought to be due to intrauterine positioning.

CLINICAL FEATURES

Signs

Inspection: Posteromedial bowing and leg length discrepancy. It is often associated with a calcaneovalgus foot. The dorsum of the foot may be in contact with the anterior tibia in this condition.
  • Leg length discrepancy: The limb is usually shortened 1-1.5 cm at birth. Some of the children will have limb length discrepancies that average 4.0 cm at maturity. The growth inhibition usually remains as a constant percentage over time.
Movement: Triceps surae weakness.

DIAGNOSIS

X-ray

Will show posteromedial bowing of tibia.

TREATMENT

Overview

There is usually spontaneous correction in the first years of life, but it rarely resolves completely. The patient should be monitored to evaluate leg length discrepancy.

Nonoperative Treatment

Indication: Most cases. 
Method: Observation. No orthotics are necessary. Angular deformity corrects spontaneously, but medial bowing may persist. Calcaneovalgus foot resolves gradually.

Operative Treatment

Leg length discrepancy (LLD):
  • Method: The growth inhibition usually remains as a constant percentage over time, thus allowing future equalization procedures can be planned. LLD can be treated with casting, contralateral epiphysiodesis or ipsilateral limb lengthening. Tibial osteotomies are usually not indicated.
Medial bowing: Osteotomy is occasionally necessary to correct medial bowing.

COMPLICATIONS AND PROGNOSIS

Complications

Leg length discrepancy (LLD): At skeletal maturity the LLD is usually in the 3 to 8 cm range (average 3-4 cm). It may necessitate an age-appropriate epiphysiodesis of the long limb.
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