Tibial torsion is a condition where the tibia bone is abnormally twisted, often leading to problems with kneecap pain.
Page updated November 2023 by Dr Sheila Strover (Clinical Editor)
With external tibial torsion - when the kneecaps are facing forwards, the feet are rotated outwards.
With internal tibial torsion, when the feet are both facing forwards the kneecaps are 'squinting' inwards.
What causes tibial torsion?
Tibial torsion is something one is born with. In small children 'in-toeing' is common. Most children will go on to have normal tibias but in a small percentage the rotational deformity unfortunately persists through into adulthood. Usually adult rotational tibial deformity causes a pidgeon-toed gait, but sometimes it is the opposite and the feet turn outwards.
What are the consequences of tibial torsion?
Because the kneecap is embedded in the tendon of the quadriceps muscle, which itself is attached via the patellar tendon to the tibia at the tibial tuberosity, torsion or twisting of the tibia may put strain on the patella which is normally constrained within its underlying groove. The torsion may lead to patellofemoral pain and patellar instabillity.
How is tibial torsion managed?
Initially all management is conservative. Children tend to grow out of the problem. But when it persists into young adulthood management is generally one of 'wait and see'. Orthotics may be helpful and physiotherapy will focus on balancing muscle strength around the knee.
If the torsion leads to symptoms in the young adult, then a de-rotation osteotomy may be the only real solution.
Quick links
Forum discussions
- External Tibial Rotation
A patient diagnoses their own torsion issue.
Peer-reviewed papers
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Citation: Snow M. Tibial Torsion and Patellofemoral Pain and Instability in the Adult Population: Current Concept Review. Curr Rev Musculoskelet Med. 2021 Feb;14(1):67-75. doi: 10.1007/s12178-020-09688-y. Epub 2021 Jan 8. PMID: 33420589; PMCID: PMC7930175.
Quote: "Tibial torsion should be considered as a potential cause of patellofemoral dysfunction in the adult population. Surgical correction in patients in whom torsion is diagnosed as the dominant cause of patella pain and instability produces good results. However, results deteriorate in patients who have undergone multiple prior surgeries, highlighting the importance of early recognition."
Relevant material -
ebook - Anterior Knee Pain - an approach to investigation
Authored by Dr Lars Blønd (Knee Surgeon). Free to download.