Posteromedial Tibial Bowing - Pediatrics

Introduction

Physiologic bowing of tibia thought to be a result of intrauterine positioning
- usually involves middle and distal third of tibia
Genetics
- no known genetic association
Associated conditions
- calcaneovalgus foot
  - posteromedial bowing is often confused with calcaneovalgus foot, another condition caused by intrauterine positioning
  - the two conditions may occur together or independently of each other
Prognosis
- most common sequelae of posteromedial bowing is average leg-length discrepancy of 3-4 cm

Presentation

Symptoms
- presents at birth
Physical exam
- posteromedial bowing
  - apex of deformity is in the distal tibia
- calcaneovalgus foot deformity
  - apex of deformity is at the ankle

Imaging

Radiographs
- recommended views
  - AP and lateral of tibia
- findings
  - will see posterior medial bowing

Treatment

Nonoperative
- observation
  - indications
    - observation is indicated for bowing deformity which usually spontaneously corrects over 5-7 years
  - make sure to follow clinically to monitor for leg length discrepancy
  - associated calcaneovalgus foot treated with observation and parental stretching
Operative
- age-appropriate epiphysiodesis of long limb
  - indications
    - projected leg length discrepancy
    - > 50% of patients end up requiring surgical intervention for LLD

Complications

Leg length discrepancy
- patient may have residual 2-5 cm leg length discrepancy at maturity
- may require age-appropriate epiphysiodesis of long limb