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Posteromedial Tibial Bowing

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Topic updated on 08/30/16 12:57pm
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
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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Qbank (4 Questions)

TAG
(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? Topic Review Topic
FIGURES: A   B   C      

1. knee instability
2. residual limb-length discrepancy
3. pseudoarthrosis
4. scoliosis
5. tarsal coalition

PREFERRED RESPONSE ▶
TAG
(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? Topic Review Topic
FIGURES: A          

1. metatarsus primus varus
2. equinovarus
3. cavovarus
4. metatarsus adductus
5. calcaneovalgus

PREFERRED RESPONSE ▶
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