Internal Tibial Torsion is an inward twist of the long shin bone – as if you held the knee end in place and screwed the tibia inwards at the ankle. Some degree of tibial torsion is normal in babies and young children. Often a large part of the twist has ‘unfurled’ by age 1 and the majority by age 6. Around 10% will have the inward rotation last into skeletal maturity and therefore into adulthood. As the toddler with tibial torsion begins to walk, trips and falls will be frequent. It is probably true that bracing with calipers and such will not improve the rate of bone unfurling. Podiatrists will often employ a special kind of orthotic called a ‘gait plate’ which can have a good effect on an in-toeing child’s posture. While this treatment does not cause the bone torsion to improve per se, it does reposition the leg to be straighter. This is done to improve co-ordination, limit muscular imbalances that come about due to poor foot and leg posture and improve the development of athletic performance during a child’s formative years.
Femoral anteversion is an inward twist of the long thigh bone – as if you held the hip end in place and screwed the femur inwards at the knee end. It becomes more noticeable between ages 2 to 4 as children naturally move into a more ‘bow legged’ position. Some inward torsion of the femur is normal in children and will usually appear to reduce after the age of 4 as the leg orientation naturally changes toward a more ‘knocked kneed’ position. Most of the degree of femoral anteversion resolves naturally by 6 to 8 years of age. As above, it is probably true that bracing with calipers and such will not improve the rate of bone unfurling. The use of a ‘gait plate’ may again be employed by a podiatrist for the reasons mentioned above.
Photos taken by the Texas Scottish Rite Hospital for Children.