What is it?

Tibial torsion is the twisting of a child’s shinbone, also known as the tibia. In most cases, tibial torsion causes a toddler’s legs and feet to turn inward (internal tibial torsion), giving them a pigeon-toed appearance. Less often, the legs turn outward (external tibial torsion). Tibial torsion affects boys and girls in nearly equal numbers. Internal or external rotation of the legs in children is almost always a variation of normal development and do not require treatment.

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Signs & symptoms

Symptoms of internal tibial torsion usually become visible between the ages of 2 and 4. As a child starts walking, their feet turn in and their legs bow out. The outward bowing of the legs (bowlegs) can help a child balance by providing a wider base of support.

Symptoms of external tibial torsion usually appear when children are slightly older, between the ages of 4 and 7. The feet or foot rotate(s) outward and may cause the child to trip or stumble often.


Your doctor will perform a physical exam and measure the rotation of your child’s legs and feet. The doctor may ask if there’s a history of inward or outward pointing feet in your family. Most of the time, doctors do not need an x-ray to diagnose this condition.


The vast majority of children with internal tibial torsion get better without medical treatment. Muscle-strengthening exercises or physical therapy may help with balance and difficulties with gait. The use of orthotics, shoe modifications, and bracing are not effective in correcting tibial torsion.

If your child has severe tibial torsion that does not improve as they grow, their doctor may recommend a surgical procedure called an osteotomy. For this procedure, the surgeon cuts the tibia bone to correct the rotation. Sometimes the fibula bone needs to be corrected as well. The bones are fixed in place with pins or a plate and screws while the bone heals.

☝️ This is not a substitute for professional medical advice. Please consult with your physician before making any medical decision.

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