ABSTRACT
The axis of the knee joint and the axis of the ankle joint are not in the same plane and during normal walking there is a mild degree of out-toeing even though the knee faces forwards. In other words, the angle between the long axis of the foot and the line of progression (the footprogression angle) is about 10° outwards normally. This is on account of some degree of normal lateral or external torsion of the tibia. If the external torsion of the tibia is excessive there is an out-toeing gait, whereas if there is no lateral torsion or if there is internal tibial torsion, there will be an in-toeing gait (Figure 12.1). Torsional deformities of the tibia may be either congenital or developmental and may be present either in association with angular deformities or as an isolated deformity. Torsional deformities of the tibia may also be seen as part of a more widespread rotational malalignment of the limb involving the femur, tibia and the foot.1,2
Cosmetic problems While in the vast majority of instances torsional deformities of the tibia may only be of concern because of the peculiar gait, in a few situations there may be more adverse implications.
