Tuesday, April 24, 2018

Tibial Bowing


Tibial bowing is not uncommon. The direction and the apex of the tibial bow can alert the clinician to the type of the deformity, its treatment, and its prognosis. Tibial bowing can occur anteriorly, laterally, anterolaterally, and posteromedially.
Anterior bowing is often associated with fibular hemimelia. This bowing may be associated with the loss of the lateral rays of the foot, equinovalgus foot deformity, tarsal coalition, and significant leg length discrepancy.


Lateral bowing is a common variation, which occurs bilaterally. This condition is mild and not associated with other problems.


Anterolateral bowing is a serious tibial bowing that may increase and lead to a fracture as well as pseudoarthrosis of the tibia. This type of bowing occurs early in infancy. Pseudoarthrosis is usually associated with neurofibromatosis. 10% of patients with neurofibromatosis will have anterolateral tibial bowing. Neurofibromatosis is found in 50% of the patients with ALB. The patient should be carefully examined for café-au-lait spots. In this type of bowing, bone ends are usually thin and the fibula may also be involved. Treatment of anterolateral bowing is bracing with total contact orthosis. In order to treat pseudoarthosis in the tibia, surgery is usually needed. Multiple options are available for surgery, and none of these options are perfect. 50% of patients may undergo amputation due to the inability to achieve healing of pseudoarthrosis.

Posteromedial bowing is a rare calcaneovalgus deformity of the foot plus leg length discrepancy. This condition usually resolves, but may have residual leg length discrepancy.