Angular Tibial Bowing

  • Four forms
    • difference consequences
    • Predictable by direction of bow
  1. Lateral bowing
    • normal variant during 1st yr of life
    • usually resolves spontaneously
  2. Anteromedial Bowing
    • usually associated with fibular hemimelia
    • associated with short tibia
    • May require leg lengthening
    • kyphosis
  3. Posteromedial Bowing
    • presents at birth with shortened limb & grossly calcaneus foot
    • Foot often lies with dorsum against anterior leg
    • usually benign packaging defect
    • Probably caused by intrauterine fracture or malposition
    • improves in first two years
    • often confused with calcaneoValgus foot
    • nothing to do with Neurofibromatosis
    • usually remodels
    • may need correction of residual deformity and most need treatment of LLD > either leg lengthening or physeodesis
    • Foot position improves in advance of bowing
    • Tibia & fibula intact both bowed
    • Bow most pronounced in distal half of each
    • Commonly both are short = problem
    • Proportional differences in lengths remain stable
    • if severe after 3 yrs > osteotomy or epiphysiodesis ?
    • associated with
      • CalcaneUsually foot
      • Triceps surae weakness
      • Extension contracture of ankle
      • Anisomelia
  4. Anterolateral Bowing
    • DangeroUsually form
    • associated with pseudarthrosis of tibia
    • Prevent fracture by bracing
    • also seen with tibial hemimelia
    • indicative of Congenital pseudarthrosis
    • rare Congenital type with duplication of first ray associated anteroLateral bow
    • Surgery
      • very difficult
      • if severely dysplastic prob need some form of rod