Congenital Posteromedial Bowing of the Tibia

Congenital posteromedial bowing of the tibia is an uncommon condition characterized by bowing and growth disturbances of the tibia and fibula, shortening of the limb, and a calcaneo-valgus deformity of the foot. The calcaneo-valgus deformity usually responds to nonoperative measures. Spontaneous resolution of the bowing deformity occurs, though often resolution is incomplete. A valgus deformity of the ankle may develop later on account of the growth abnormalities of the tibia and fibula. Occasionally, weakness of plantarflexors of the ankle may be demonstrable and be severe enough to cause a limp. Treatment is warranted to correct residual bowing of the tibia, to equalize the limb lengths, to correct the valgus deformity of the ankle, and to improve the power of plantar flexion. The treatment options include corrective osteotomy and acute correction of the tibial bowing, gradual correction of the deformity with the help of an external fixator, contralateral proximal tibial epiphysiodesis, or ipsilateral limb lengthening to equalize limb lengths, physeal manipulation of the distal tibia to correct the ankle valgus, and a tendon transfer to augment the plantarflexors.