So what do these dogs tell us?

These are pedographs of a 12 year old male who was brought into the office last week by his mother with knee pain, bilaterally, R > L and bilateral hip pain.

Clinical findings are a left tibial and femoral leg length deficiency of over 1 cm; bilateral internal tibial torsion in excess of 40 degrees; no femoral retro or ante torsion.

Gait evaluation revealed moderate rear and midfoot pronation. He leaned to the left during stance phase on the left. Arm swing had bilateral symmetry.

So, what can you tell us about internal tibial torsion?

The tibial torsion angle is measured by looking at the angle of the tibial plateau and the intermaleolar line (see middle picture above). The distal tibia begins in utero having an angle of 0 degrees in the infant an “untwists” to 22 degrees by adulthood (see far right). Tom Michaud does a great job talking about this in this book “Human Locomotion: The conservative Management of Gait Related Disorders”. When it moves less than the requisite amount (possibly due to biomechanical. genetic or environmental influences), you get internal tibial torsion. This means the foot is pointed inward when the knee is in the coronal plane (ie facing straight forward)