KidsMD Health Topics

Tibial Torsion

  • Overview

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

    When your 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. 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 Boston Children's Hospital approaches tibial torsion

    Doctors at Children's try to make sure that your child's legs can straighten themselves naturally. If this doesn't work, doctors may require your child to wear corrective leg braces. Only the most severe cases would require surgery.

    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 2
    Boston MA 02115
     617-355-6021

  • In-Depth

    Should I be concerned with my baby's progress in walking?

    Below are considered average developmental milestones in your baby's ability to walk:

    • 6-10 months - most babies learn to pull themselves up to a standing position.
    • 7-13 months - most babies will be moving about while holding on to furniture for support. Babies can walk with support from a parent (but don't force them into walking on their own).
    • 11-14 months- most babies will start to walk on their own, usually by 14 months.

    Walking with pigeon-toes is a normal part of your baby's walking progress, even when caused by tibial torsion, which should straighten itself out as your baby learns to walk. If it doesn't, consult your baby's doctor.

    What causes tibial torsion?

    Tibial torsion can occur due to the position of the baby in the uterus. It also has a tendency to run in families. Typically, a child's walking style looks like that of his/her parents.

  • Tests

    How does a doctor know my child actually has tibial torsion?

    During a physical examination by your child's doctor, the doctor obtains a complete prenatal and birth history of your child and asks if other family members are known to have tibial torsion.

    In addition, some doctors place ink or chalk on the bottom of the child's feet and have them walk on paper to evaluate the amount of intoeing the child has.

    Other diagnostic procedures may include:

    • X-rays - A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film
    • Magnetic Resonance Imaging (MRI) - A diagnostic procedure that uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves
    • Computerized Tomography Scan (also called a CT or CAT scan)- A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images (often called "slices"), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general X-rays
  • How does a doctor treat tibial torsion?

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

    • your child's age, overall health, and medical history
    • the extent of the condition
    • your child's tolerance for specific medications, procedures, or therapies
    • expectations for the course of the condition
    • your opinion or preference.

    The twisting of the shin bones usually improves with time. As the child grows, walking will become more normal, usually around 5 to 8 years of age.

    Occasionally, braces or special shoes are prescribed by the physician.

    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.

    It is important to know that tibial torsion does not lead to arthritis or any other future health problems.

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