Pappas followed 33 patients with congenital posteromedial tibial bowing from birth to skeletal maturity. The study defines how angular deformity and limb length discrepancy evolve over time. It answers whether early measurements can reliably predict the degree of shortening that will require surgical correction at maturity.
When a newborn presents with a striking calcaneovalgus foot and bowed tibia, the key question parents ask is: how bad will this get? This paper gives you the answer with numbers.
Document the bowing angle at birth — it correlates strongly (r = 0.84) with mature limb length discrepancy. After age 12 months, measure the proportionate shortening: it will hold at 12–13% for the rest of childhood, letting you project the mature discrepancy and time epiphysiodesis accurately. Estimates made at age 3 are within 2 mm of mature values, so early planning is both possible and reliable.
Every patient in this series ultimately needed surgical equalization (mean 4.1 cm shortening at maturity). Reassure parents that the bowing itself corrects substantially, but prepare them that the leg length discrepancy is inevitable and will be managed surgically. One durable nuance: the posterior bow corrects well, but residual medial bowing and a permanent ankle plantarflexion deficit are expected. Neither responds to stretching or bracing.
Pappas followed 33 patients with congenital posteromedial tibial bowing from birth to skeletal maturity. The study defines how angular deformity and limb length discrepancy evolve over time. It answers whether early measurements can reliably predict the degree of shortening that will require surgical correction at maturity.
When a newborn presents with a striking calcaneovalgus foot and bowed tibia, the key question parents ask is: how bad will this get? This paper gives you the answer with numbers.
Document the bowing angle at birth — it correlates strongly (r = 0.84) with mature limb length discrepancy. After age 12 months, measure the proportionate shortening: it will hold at 12–13% for the rest of childhood, letting you project the mature discrepancy and time epiphysiodesis accurately. Estimates made at age 3 are within 2 mm of mature values, so early planning is both possible and reliable.
Every patient in this series ultimately needed surgical equalization (mean 4.1 cm shortening at maturity). Reassure parents that the bowing itself corrects substantially, but prepare them that the leg length discrepancy is inevitable and will be managed surgically. One durable nuance: the posterior bow corrects well, but residual medial bowing and a permanent ankle plantarflexion deficit are expected. Neither responds to stretching or bracing.