tibial torsion

Tibial torsion is a persistent twist in the tibias (shin bones) caused by the cramped positioning in utero. It is nothing to worry about. Nature will straighten this twist, because bones are living tissue, not inert rocks. They are constantly broken down and rebuilt along the proper lines of stress bearing and will thus naturally straighten. Toddler's feet commonly point in for several months to a year after they begin to walk on their own.

Parents get tense about their toddlers' feet turning in, or tibial torsion, usually around 15 - 18 months. They say, "There's something wrong with his foot." Actually, if you look at the foot carefully, you'll see that it is perfectly normal. It is not bent. It seems to hang normally on the ankle joint. Now, how does the foot line up with the knee, that is does it point in the same direction as the thigh. No, it seems to point in towards the center of the body. It is the lower leg (the tibia) that is twisted.

Technically, your doctor will simply look at the angle made by drawing an imaginary line across the knee hinge joint and comparing that to the imaginary line that runs through the two bony prominences on either side of the ankle. That line should make an angle similar to the one you measure on your own leg. Notice that the inner prominence (medial malleolus) of your ankle is carried forward than the outer one (lateral malleolus). In your toddler with intoeing, by feeling these malleoli with one hand while holding the knee bent with the other hand you will see that his little shin bone is twisted inward, and thus the foot is carried in a toe-in alignment.

How did this happen? Well, it is very, very common, because it is simply caused by the twisting effect on soft fetal bones of the cramped intrauterine position. The medical name is internal tibial torsion. It corrects itself as the leg grows - it will naturally straighten, but not until the child has been walking on his own for quite a while. Most children have self-corrected by age 7-8 years old, if not much earlier.

How do we treat it? Doctors used to prescribe orthopedic shoes and a cumbersome bar device (Denis Browne bar) that supposedly twisted the shin bones back straight when worn at night. We don't use these things anymore for tibial torsion because they cost a lot, annoy the child, and don't seem to work any better or faster than Mother Nature. (see knock knees) A controlled study found no effect of treatment (Orthopedics, June 1991).

Parents of intoeing children can take some small comfort that adult runners who intoe just a bit are faster on average than those who do not.

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