Tibial torsion describes a rotational alignment variation of the shin bone, known as the tibia. This article explores what tibial torsion entails, how it is identified, its causes, and its management.
Understanding Tibial Torsion
Tibial torsion causes the foot to point inward or outward relative to the knee. Internal tibial torsion involves an inward twist of the tibia, resulting in the foot turning inward and often leading to an in-toeing gait.
Conversely, external tibial torsion involves an outward twist of the tibia, causing the foot to point outward and resulting in an out-toeing gait. This rotational difference is an anatomical variation rather than a disease, affecting the alignment of the lower leg from the knee down to the ankle.
Identifying Tibial Torsion
The primary observable sign of tibial torsion is an altered walking pattern, specifically in-toeing or out-toeing. Children with internal tibial torsion might frequently trip, especially when running, because their feet turn inward during movement. Parents may also notice the child’s feet or knees appear to point inward or outward when standing or walking.
Healthcare professionals assess tibial torsion through a physical examination, observing the child’s gait and how their feet and knees align. They measure the rotational alignment of the lower leg bones, such as the thigh-foot angle, through visual assessment or specialized tools. This evaluation helps determine the degree of the twist and differentiate it from other rotational issues.
Causes of Tibial Torsion
Tibial torsion develops due to the baby’s position within the womb. The confined space can cause developing long bones, including the tibia, to rotate as they grow. This in-utero positioning is a primary factor for many cases.
As children grow, their bones naturally remodel and adapt, often correcting the rotational difference over time. While often a normal developmental variation, a genetic predisposition can also exist. In some instances, underlying conditions could contribute, but these are less common.
Managing Tibial Torsion
In most cases, particularly in children, tibial torsion resolves spontaneously without intervention. The body’s natural growth process corrects the rotational alignment of the tibia as the child matures, often by the age of 8 to 10 years. For this reason, healthcare providers recommend a period of observation, known as “watchful waiting.”
Non-surgical options, such as physical therapy, may be considered but do not “untwist” the bone. Physical therapy focuses on improving muscle strength, flexibility, and overall gait mechanics, which can help compensate for the rotational difference. Braces, special shoes, or orthotics are not effective in correcting true tibial torsion because the issue lies within the bony structure itself, not in the foot or soft tissues. Surgical intervention is rarely necessary and is reserved for severe cases that persist into late childhood or adolescence, cause functional impairment, or result in persistent pain.