What is internal tibial torsion?

The tibia is the larger of the two bones in the lower leg. It is also known as the shin bone. Internal tibial torsion is an inward twisting of the tibia, which leads to in-toeing of the foot. Although it may not be noticeable until your child starts to walk, this condition is often present since birth. Internal tibial torsion usually affects both legs and could be related to the child’s position in the uterus.

What are the symptoms of internal tibial torsion?

Intoeing is the most visible symptom of internal tibial torsion. It means that the feet are noticeably angled toward each other when a child walks or stands. Other common causes of intoeing include femoral anteversion (twisting of the hip bone) and metatarsus adductus (curved foot).

There is usually no pain associated with internal tibial torsion. However, a child with this condition may trip and fall more frequently.

Internal Tibial Torsion Diagnosis

Internal tibial torsion can be diagnosed through a physical exam and measurements of the legs.

Internal Tibial Torsion Treatment

This condition usually improves without treatment by about 4 years of age. Bracing, casting and physical therapy are not usually needed. A child’s growth is closely monitored to ensure the internal tibial torsion resolves on its own. If the tibia is still significantly twisted by age 9 or 10, then a surgery may be recommended to correct it.

The surgery to correct internal tibial torsion is called tibial derotational osteotomy. During this procedure, the tibia is cut, rotated and fixed in a straighter position. Following surgery, casting will be required to allow for healing of the bone. Your orthopaedic specialist may also recommend physical therapy to help your child return to a normal walking pattern.