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Tibial torsion refers to the rotation or twist along the longitudinal axis of the lower leg or more specifically the tibial bone.
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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:
- transtibial axis: defined by bisection of the proximal tibial plateau passing through the center
- posterior condylar axis: tangent to the posterior tibial plateau above the proximal tibiofibular joint
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.
- 1. Rerucha C, Dickison C, Baird D. Lower Extremity Abnormalities in Children. Am Fam Physician. 2017;96(4):226-33. - Pubmed
- 2. Shin S, Yoon C, Lee E et al. The Availability of Radiological Measurement of Tibial Torsion: Three-Dimensional Computed Tomography Reconstruction. Ann Rehabil Med. 2011;35(5):673. doi:10.5535/arm.2011.35.5.673 - Pubmed
- 3. Madadi F, Madadi F, Maleki A, Shamie A, Washington E, Yazdanshenas H. A New Method for Tibial Torsion Measurement by Computerized Tomography. Journal of Orthopaedics. 2016;13(1):43-7. doi:10.1016/j.jor.2015.09.001 - Pubmed
- 4. Rosskopf A, Ramseier L, Sutter R, Pfirrmann C, Buck F. Femoral and Tibial Torsion Measurement in Children and Adolescents: Comparison of 3D Models Based on Low-Dose Biplanar Radiography and Low-Dose CT. AJR Am J Roentgenol. 2014;202(3):W285-91. doi:10.2214/AJR.13.11103 - Pubmed
- 5. Liodakis E, Doxastaki I, Chu K et al. Reliability of the Assessment of Lower Limb Torsion Using Computed Tomography: Analysis of Five Different Techniques. Skeletal Radiol. 2011;41(3):305-11. doi:10.1007/s00256-011-1185-4 - Pubmed
- 6. Keppler P. Behandlung Von Torsionsabweichungen Am Unterschenkel. Unfallchirurg. 2018;121(3):191-8. doi:10.1007/s00113-017-0452-9 - Pubmed
- 7. Schenk P, Vlachopoulos L, Hingsammer A, Fucentese S, Fürnstahl P. Is the Contralateral Tibia a Reliable Template for Reconstruction: A Three-Dimensional Anatomy Cadaveric Study. Knee Surg Sports Traumatol Arthrosc. 2016;26(8):2324-31. doi:10.1007/s00167-016-4378-5 - Pubmed