Tibial torsion

Last revised by Joachim Feger on 28 Nov 2021

Tibial torsion refers to the rotation or twist along the longitudinal axis of the lower leg or more specifically the tibial bone.

Internal tibial torsion is a cause of in-toeing gait a common rotational variant in toddlers, usually resolving spontaneously by the age of 5 years 1. External tibial torsion is a cause of out-toeing and is less common, usually occurring later at an age of 4-7 years 1.

A severe residual deformity can result in functional and cosmetic or psychological disorders or can even cause osteoarthritis or chondromalacia patellae if serious 2.

Apart from clinical measurements different imaging methods (2D-CT and 3D-CT) have been suggested with various reference axis used 2-6.

proximal reference axes are the following:

the following distal reference axes are used:

  • a line through the middle of two ellipses marked by the fibular notch and the medial malleolus 5,6
  • bimalleolar or transmalleolar axis: bisection of the tibial plafond, connecting the most protruding parts of the medial and lateral malleolus to measure tibiofibular torsion 5,6

Normal values differ with the imaging method and reference axes. Intraindividual rotational side differences >15° are considered abnormal 6,7.

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