Tibial Torsion

Tibial torsion is an inward twisting of the shin bones (the bones that are located between the knee and the ankle). Tibial torsion causes the child's feet to turn inward, or have what is also known as a "pigeon-toed" appearance. It is typically seen among toddlers.

What causes tibial torsion?

Tibial torsion occurs due to the position of the baby in the uterus which results in an inward twist to the bone. The bone typically untwists as the child grows but this is a very slow and gradual process.  It also has a tendency to run in families. Typically, a child's walking style looks like that of his or her parents.

When the child is first learning how to walk, tibial torsion can create an intoeing appearance. As the feet toe in, the legs look like they are bowed. The bowed leg stance actually helps children achieve greater balance as they stand as it gives them a wider base of support. Their balance is not as steady when they try to stand and walk with their feet close together or with their feet turned out. This may cause them to trip and fall.

How is tibial torsion diagnosed?

The diagnosis of tibial torsion is made by a history and physical examination by your child's doctor. During the examination, the doctor obtains a complete prenatal and birth history of the child and asks if other family members are known to have tibial torsion. Typically, the diagnosis is made without an X-ray.

Treatment for tibial torsion

Specific treatment for tibial torsion will be determined by your child's doctor based on:

  • Your child's age, overall health, and medical history
  • The severity of the condition
  • Your child's tolerance for procedures or therapies
  • Expectations for the course of the condition

The twisting of the shin bones usually improves with time. As the child grows, walking will become more normal, usually around 7 to 8 years of age.

Most studies have found that braces or special shoes do not help this condition.

Long-term outlook for tibial torsion

Tibial torsion has a very good prognosis. Many cases correct themselves as the child grows. On rare occasions, tibial torsion can be severe and surgery may be required to straighten the shin bones.  Surgery is typically considered after 10 years of age as the torsion is unlikely to change after this age.

It is important to know that tibial torsion does not lead to arthritis or any other future health problems and in fact many college and professional athletes have tibial torsion.

Diagnosis and Treatment Available at Texas Children’s:

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