With external tibial torsion, when the kneecaps are facing forwards, the feet are rotated outwards.
With internal tibial torsion, when the feet are both facing forwards the kneecaps are 'squinting' inwards.
What causes tibial torsion?
Tibial torsion is something one is born with.
In small children 'in-toeing' is common. Most children will go on to have normal tibias but in a small percentage the rotational deformity unfortunately persists through into adulthood.
Usually adult rotational tibial deformity causes a pidgeon-toed gait, but sometimes it is the opposite and the feet turn outwards (external tibial torsion).
Quick linksWhat are the consequences of tibial torsion?
Because the kneecap is embedded in the tendon of the quadriceps muscle, which itself is attached via the patellar tendon to the tibia at the tibial tuberosity, torsion or twisting of the tibia may put strain on the patella which is normally constrained within its underlying groove.
The torsion may lead to patellofemoral pain and patellar instabillity.
Peer-reviewed papersQuote from peer-reviewed paper:
"....Tibial torsion should be considered as a potential cause of patellofemoral dysfunction in the adult population. Surgical correction....produces good results. However, results deteriorate in patients who have undergone multiple prior surgeries, highlighting the importance of early recognition...."
Citation: Snow M. Tibial Torsion and Patellofemoral Pain and Instability in the Adult Population: Current Concept Review. Curr Rev Musculoskelet Med. 2021 Feb;14(1):67-75. doi: 10.1007/s12178-020-09688-y. Epub 2021 Jan 8. PMID: 33420589; PMCID: PMC7930175.
How is tibial torsion managed?
Initially all management is conservative. Children tend to grow out of the problem.
But when it persists into young adulthood management is generally one of 'wait and see'. Orthotics may be helpful and physiotherapy will focus on balancing muscle strength around the knee.
If the torsion leads to symptoms in the young adult, then a de-rotation osteotomy may be the only real solution.
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