INTRODUCTION
Definition
Congenital posteromedial bowing of tibia.Epidemiology
Associated with leg length discrepancy, calcaneovalgus foot, and tight anterior structures.- It is not associated with other anomalies such as neurofibromatosis or with tibial fractures or pseudoarthrosis.
Pathoanatomy
Usually affects the middle and distal thirds of the tibia.Etiology
Thought to be due to intrauterine positioning.CLINICAL FEATURES
Signs
Inspection: Posteromedial bowing and leg length discrepancy. It is often associated with a calcaneovalgus foot. The dorsum of the foot may be in contact with the anterior tibia in this condition.- Leg length discrepancy: The limb is usually shortened 1-1.5 cm at birth. Some of the children will have limb length discrepancies that average 4.0 cm at maturity. The growth inhibition usually remains as a constant percentage over time.
DIAGNOSIS
X-ray
Will show posteromedial bowing of tibia.TREATMENT
Overview
There is usually spontaneous correction in the first years of life, but it rarely resolves completely. The patient should be monitored to evaluate leg length discrepancy.Nonoperative Treatment
Indication: Most cases.Method: Observation. No orthotics are necessary. Angular deformity corrects spontaneously, but medial bowing may persist. Calcaneovalgus foot resolves gradually.
Operative Treatment
Leg length discrepancy (LLD):- Method: The growth inhibition usually remains as a constant percentage over time, thus allowing future equalization procedures can be planned. LLD can be treated with casting, contralateral epiphysiodesis or ipsilateral limb lengthening. Tibial osteotomies are usually not indicated.