Lateral bowing is not uncommon in infants and is normal in a child less than 2 years old. It can be caused by a growth disturbance of the tibial epiphysis and the tibial shaft.
- common from birth to the early toddler, often with out-toeing (maximal at approx. 1 year); most resolve by 18 months (1)
Consider and exclude rickets - particularly in individuals with a high phytate intake e.g. chapati eaters and vegetarians.
Measurement of the degree of deformity can be achieved by:
- getting the patient to stand with both patellae facing forward and then measuring the distance between them
- radiographic estimation: the angle between the longitudinal axes of both the femur and the tibia
Severe deformation may be amenable to osteotomy.
- anterior bowing is always significant; causes include:
- congenital absence of the fibula
- neurofibromatosis type 1
- osteogenesis imperfecta
- posterior bowing:
- is rare
- looks serious, but usually responds to simple stretching and splinting
- ARC. Sports-Related Musculoskeletal Disorders. Reports on the Rheumatic Diseases 2008;14.