Classification
Tibial Bowing
- Physiological genu varum, normal in infants and toddlers, corrects by about age 2
- Physiological genu valgum, peaks around 3 to 4 years, corrects spontaneously
- Posteromedial bowing, calcaneovalgus foot, spontaneous correction with leg length discrepancy
- Anterolateral bowing, associated with NF1 and progression to congenital pseudarthrosis
- Anteromedial bowing, associated with fibular hemimelia and leg shortening
Blount Disease
- Infantile form, under 4 years, obese early walkers, Langenskiold stages
- Adolescent form, over 10 years, obese, unilateral more common, milder deformity
- Metaphyseal diaphyseal angle over 16 degrees suggests Blount disease
Congenital Pseudarthrosis of the Tibia
- Anterolateral bowing progressing to fracture and non union
- Strong association with NF1
- Treatment with excision, intramedullary fixation, bone graft or Ilizarov
- Amputation for repeated failure
Hemimelia
- Fibular hemimelia, most common long bone deficiency, short tibia, ball and socket ankle
- Tibial hemimelia, rare, absent or deficient tibia, Jones classification
- Tibial hemimelia may need knee disarticulation or fibular transfer
Rotational Disorders
- Internal tibial torsion, common cause of intoeing in toddlers, resolves spontaneously
- External tibial torsion, may worsen with age, linked to patellofemoral pain
Fractures and Overuse
- Toddler’s fracture, undisplaced spiral distal tibial fracture in children 1 to 4 years
- Proximal tibial stress fracture, athletic teenagers
- Osgood-Schlatter disease, traction apophysitis of the tibial tubercle
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.