Angular Deformity of Lower Legs

Angular Deformities of the Lower Leg
Dr. Robert Sheinberg, DPM, DABFAS, FACFAS

The fetal position of the lower limb in utero shows the lower leg is internally rotated (medial tibial torsion) and in a bowed posture. As the child begins to walk normal physiologic unwinding takes place in the lower limbs. The legs grow from a bowlegged posture at birth to a position by age two whereby the knees are relatively straight. They then start to approach more of a knock-kneed posture that is maximized by age 4. After age 4 the knock-kneed posture starts to minimize but does not completely resolve. Adult values are usually reached between 10 and 12. This adult value places the knee into a slight valgus (knock-knee alignment). Knee alignment at birth shows a varus position of approximately 10-15 degrees. It peaks to 10-15 degrees of valgus at approximately age 3-1/2 to 4 years.

Tibial Varum in 2 year old