ArticleJournal of the Pediatric Orthopaedic Society of North America2025
Clinical Measures Associated With Tibial Torsion in Ambulatory Children With Cerebral Palsy and Pes Valgus.
Article in Journal of the Pediatric Orthopaedic Society of North America, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
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Authors and funding
5 authors.
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Abstract
Background: Transverse plane alignment deviations in individuals with cerebral palsy (CP) contribute to lever arm dysfunction. The cause of this is often multifactorial. External tibial torsion and pes valgus are both possible causes. Tibial torsion could be missed without detailed clinical exam. The purpose of this study was to examine factors associated with external tibial torsion in patients with CP and pes valgus. Methods: We retrospectively examined patients with CP who had pes valgus. Participants underwent clinical examination, including transmalleolar axis angle (TMA). TMA >20° external was considered clinically significant external tibial torsion. The association of TMA and external tibial torsion to demographic and clinical examination data were examined. Results: Two hundred forty-seven patients were included with 422 valgus feet (175 bilateral). External tibial torsion was observed in 11.6% of limbs. Tibial torsion became more external with age (β = 0.12, 95% CI = [0.02, 0.22], Conclusions: External tibial torsion as a possible contributor to transverse plane malalignment needs to be considered in older patients with CP who have pes valgus with limited hindfoot inversion ROM. Our results highlight that external tibial torsion increases with age, increased dorsiflexion, and limited hindfoot inversion ROM. Overlooking external tibial torsion when correcting pes valgus could result in under correction of malalignment and continued functional limitations related to lever arm dysfunction. Key Concepts: (1)The causes of external foot progression are often multifactorial, including both external tibial torsion and pes valgus.(2)External tibial torsion needs to be considered as a possible contributor to transverse plane malalignment in older patients with CP with pes valgus and limited hindfoot inversion ROM.(3)Failure to recognize external tibial torsion may lead to undercorrection of lever arm dysfunction for patients with CP. Level of Evidence: III.
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