Rehabilitation of Children Affected by Congenital Posteromedial Bowing of the Tibia: A Case Report

Abstract

Background: Posteromedial bowing of the tibia (CPMBT) is a rare congenital lower extremity disorder typically associated with calcaneovalgus foot deformity and extreme ankle dorsiflexion that can lead to leg length discrepancy (LLD) later in life. The management of CPMBT includes several therapeutic options, but the treatment of choice remains controversial. Given the tendency to spontaneous leg bowing correction, some authors suggest an initial conservative treatment consisting of manipulation, serial casting, orthoses and shoe lifts during the first four years of life, leaving surgical limb equalization closer to skeletal maturity. Methods: An Asian girl born at 38 weeks of gestational age, affected by left congenital posteromedial bowing of the tibia and ipsilateral calacaneo valgus deformity was exclusively treated with conservative orthopedic management and rehabilitation physiotherapy. Results: The integrated approach of serial casting and splinting in conjunction with early physiotherapy was effective to resolve the calcaneo valgus foot deformity and to significantly correct the left leg bowing and LLD. Moreover, adequate gross motor development was achieved as evidenced by periodic AIMS score assessment. Conclusions: Conservative management with intermittent plaster casting and rehabilitation treatment during the first years of life can significantly improve congenital leg bowing, calcaneo valgus deformity and leg length discrepancy. We believe that our experience can contribute to build up a standardized rehabilitation protocol to minimize the need for surgery in CPMBT patients. Future studies should compare the motor skill development of children with CPMBT that underwent conservative orthopedic management and rehabilitation treatment with children who only underwent conservative orthopedic management.