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Updated: Jun 14 2021

Posteromedial Tibial Bowing

Images photo - courtesy Miller_moved.png vs. postero medial bowing.jpg - AP - lat leg - courtesy Miller_moved.png 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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