Tibial Torsion

Tibial torsion refers to a twist in the tibia. The tibia is the main bone in the lower leg. This health problem occurs before birth as the baby grows inside the small space of the uterus. Most often, it involves “in-toeing." This means the feet point toward each other when the knees are bent. Much less common is “out-toeing” where the feet turn away from each other. Some degree of tibial torsion is normal during infancy. It may affect one leg more than the other.

When the child starts to stand and then to walk, the tibial torsion starts to fix itself naturally. For in-toeing, this often occurs 6 to 12 months after the child starts to walk. This self-correcting process continues during childhood. By age 7 to 8 years, most children have corrected their tibial torsion without any special treatment. Out-toeing is less likely to fix itself. But it often does not cause long-term problems.

In the past, standard treatment for in-toed tibial torsion was special orthopedic shoes connected by a bar. This was worn at night to hold both feet in a toe-out position. But it was later learned that children recovered from tibial torsion just as quickly without this splint. So now, the splint is no longer used and most children do fine.

If the feet still turn in more than 15 degrees by 5 years of age, that is a sign that they might not self-correct. In very rare cases, surgery may be needed. But surgery for this problem is often delayed until the child is between 7 to 10 years old.