Correcting external tibial torsion: treatment options

Patient

Q: I have a relatively pronounced external tibial torsion; 42 degrees on my left leg and 30 degrees on my right leg. I am 22 years old and a very active running athlete. However, I have also had a relatively long history of injuries that my sports trainers says are related to my overpronation caused by this external tibial torsion. I definitely do actively perceive that my running form is slightly uncomfortable and inefficient, but it is the way I've always run. Is this something I should be looking to fix with surgery? Or might this actually ruin my ability to run, since I have grown up running this way?

Doctor

A:    I strongly recommend you to get an appointment with an Orthopedic Surgeon and have a comprehensive evaluation, physical exam and imaging tests to assess the functional repercussion of your tibial torsion and from there decide if you are or not candidate for surgical treatment. In children, the treatment with orthoses generally is ineffective. The condition has a benign natural history. Because most cases resolve spontaneously, observation with yearly review is all that is generally needed. Cast correction by using a long leg cast can be attempted. A weekly cast change for 4-5 weeks is generally needed. The surgical treatment is called Osteotomy, and is indicated if deformity is more than 3 standard deviations (SDs) from the mean (less than -10º or more than +35º). Osteotomies (supramalleolar osteotomy) can be performed at any level to correct the deformity. Also, osteotomies can be performed in the distal tibia and fibula, which can be derotated as one functional piece, avoiding alteration of the ankle mechanics.

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