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  • Writer's pictureRobin R Varghese, PT.

"Tibial Torsion". Let us detangle the chaotic twists and help your child get the best services ever.

What is Tibial Torsion?

  • Tibial torsion is defined as any twisting of the tibia on its longitudinal axis which produces a change in the alignment of the planes of motion of the proximal and distal articulations.

  • It is an intraosseous external or internal twisting of the tibia.

  • Tibial torsion is a recognized cause of patellofemoral pain and instability in the paediatric population. It is also a concern in adult population.

  • Pathological tibial torsion is known to negatively influence the functionality of the lower extremity

  • Tibial torsion can have a significant effect on gait and muscle function,

  • This can result in joint overload and disturbed patellofemoral mechanics

  • In most cases, tibial torsion causes a toddler’s legs and feet to turn inward (internal tibial torsion), giving them a pigeon-toed appearance. Less often, the legs turn outward (external tibial torsion).

  • Internal or external rotation of the legs in children is almost always a variation of normal development and do not require treatment.

  • Tibial torsion is a common cause of gait abnormalities

  • Almost all children with internal tibial torsion get better without treatment, usually by the time they turn 4.

  • By contrast, external tibial torsion can become more serious during periods of rapid growth in late childhood and the early teen years. It usually affects both legs.

  • Isolated tibial torsion can lead to a variety of secondary compensatory or induced kinematic abnormalities during gait. Maximum compensation occurs at the hip and then becomes less effective, proceeding distal to the foot, wherein the foot minimally compensates through midfoot pronation .


  • Symptoms of internal tibial torsion usually become visible between the ages of 2 and 4.

  • As a child starts walking, their feet turn in and their legs bow out.

  • The outward bowing of the legs (bowlegs) can help a child balance by providing a wider base of support.

  • Symptoms of external tibial torsion usually appear when children are slightly older, between the ages of 4 and 7. The feet or foot rotate(s) outward and may cause the child to trip or stumble often.


  • Exact etiology is unknown

  • It is believed to be caused by intra-uterine positioning and molding

  • Internal tibial torsion is often caused by a baby’s position in their mother’s uterus. The change begins in utero and progresses throughout childhood and adolescence to skeletal maturity.

  • It is also likely influenced by local biomechanical factors, genetics and a range of pathologies.

Normal Values of Tibial Torsion

LeDamany in 1909 was the first to report on the normal values of tibial torsion. Using anthropometry, he found the mean value in 100 specimens to be 23.7°.


· Diagnosis is made clinically with a thigh-foot angle > 10 degrees of internal rotation in a patient with an in-toeing gait.


  • Treatment is often not needed. The condition usually improves as the child grows.

  • Surgical management called osteotomy is indicated in children > 6-8 years of age with functional problems and thigh-foot angle >15 degrees.

  • Muscle-strengthening exercises and other physical therapy approaches may help with balance and difficulties with gait.

Clinical picture demonstrating the inward-pointing knee and the typical “knee in” gait of a patient with tibial torsion. Compensatory internal rotation of the hip results in a dynamic valgus and a resulting lateral vector on the patella.


  • A Tibial torsion range of 24° to 30° seems to correspond to normal values for external tibial torsion for patients of European origin

  • Surgical correction in patients in whom torsion is diagnosed as the dominant cause of patella pain and instability produces good results

  • Tibial torsion commonly develops in children with motor dysfunctions, such as cerebral palsy due to the abnormal muscle and fascial tensions.

  • Bracing/orthotics do not change natural history of condition

Thigh-foot angle

At Valley Healing Hands, we provide the best physical therapy treatment for patients with Tibial torsion. Our physical therapists are highly qualified and will perform a comprehensive assessment, diagnosis, and treatment for children with tibial torsion. We also treat adults with the same complaints. We also do take care of other conditions affecting their lower limbs. We have extensive experience in treating many disorders requiring physical therapy services. Our patients are satisfied with our services. You may learn what they have to say about us here and get connected to us here.


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