Updated: 4/26/2021

Posteromedial Tibial Bowing

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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
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

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