Updated: 6/14/2021

Posteromedial Tibial Bowing

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Images
https://upload.orthobullets.com/topic/4057/images/Clinical photo - courtesy Miller_moved.png
https://upload.orthobullets.com/topic/4057/images/cvf vs. postero medial bowing.jpg
https://upload.orthobullets.com/topic/4057/images/Xray - AP - lat leg - courtesy Miller_moved.png
https://upload.orthobullets.com/topic/4057/images/posteriomedial tibial bowing xray.jpg
  • Summary
    • Posteromedial Tibial Bowing is a congenital condition thought to be a result of intrauterine positioning that typically presents with a calcaneovalgus foot deformity and leg length discrepancy.
    • Diagnosis is made radiographically with xrays of the tibia.
    • Treatment is observation for bowing deformity which usually spontaneously corrects over 5-7 years. If leg-length discrepancy develops, nonoperative or operative management may be indicated depending on the severity of the discrepancy. 
  • Epidemiology
    • Anatomic location
      • usually involves middle and distal third of tibia
  • Etiology
    • 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
  • 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
  • Prognosis
    • Sequelae
      • Most common sequelae of posteromedial bowing is average leg-length discrepancy of 3-4 cm

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(OBQ08.11) An infant is born with a unilateral lower extremity deformity. A clinical photo is shown in figure A. Radiographs are shown in figure B. Which of the following conditions are associated with this type of deformity?

QID: 397
FIGURES:
1

knee instability

5%

(98/1851)

2

residual limb-length discrepancy

63%

(1167/1851)

3

pseudoarthrosis

16%

(297/1851)

4

scoliosis

8%

(139/1851)

5

tarsal coalition

8%

(144/1851)

L 3 B

Select Answer to see Preferred Response

(OBQ07.23) A 3-month-old child presents with the tibial deformity seen in Figure A. What foot deformity is commonly associated with this condition?

QID: 684
FIGURES:
1

metatarsus primus varus

2%

(39/2006)

2

equinovarus

12%

(232/2006)

3

cavovarus

9%

(172/2006)

4

metatarsus adductus

11%

(223/2006)

5

calcaneovalgus

66%

(1325/2006)

L 2 B

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Evidence (5)
VIDEOS & PODCASTS (1)
EXPERT COMMENTS (9)
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