Tibial Torsion Test

Tibial torsion is inward twisting of the tibia (tibia/shinbone:the bones that are located between the knee and the ankle) and is the most common cause of intoeing. It is usually seen at age 2 years. Males and females are affected equally, and about two thirds of patients are affected bilaterally. The differences in normal tibial torsion values are expected to be caused by the different lifestyles and postures of the different populations, such as cross-legged sitting positions.

Signs and Symptoms:

Tibial torsion causes the feet to turn inward, or have what is also known as a “pigeon-toed” appearance.

The ability to compensate for tibial torsion depends on the amount of inversion and eversion present in the foot and on the amount of rotation possible at the hip. Internal torsion causes the foot to adduct, and the patient tries to compensate by everting the foot, externally rotating at the hip, or both.

Similarly, persons with external tibial torsion invert at the foot and internally rotate at the hip. Whereas medial torsion improves with time, lateral torsion often worsens because the natural progression is toward increasing external torsion.
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Summary:

• Tibial torsion is inward twisting of the tibia (shinbone) and is the most common cause of intoeing.
• It is usually seen at age 2 years.
• About two thirds of patients are affected bilaterally.

Orthopedic Exam / Special Tests for Physical Therapy: Leg

Special Test: Tibial Torsion Test (Seated, Supine, Prone)

Special Test: Tibial Torsion Test PROCEDURE (Seated): 

• tibial torsion is measured by having the patient sit with the knees flexed to 90° over the edge of the examining table.
• the examiner places the thumb of one hand over the apex of one malleolus and the index finger of the same hand over the apex of the other malleolus.
• the examiner visualizes the axes of the knee and of the ankle.

Tibial Torsion Test: POSITIVE TEST:

• The lines are not normally parallel but instead form an angle of 12° to 18° owing to lateral rotation of the tibia.

2. Tibial Torsion Test – SUPINE Video Instructions (Procedure below)

Special Test: Tibial Torsion Test PROCEDURE (Supine): 

• the examiner ensures that the femoral condyle lies in the frontal plane (patella facing straight up).
• the examiner palpates the apex of both malleoli with one hand and draws a line on the heel representing a line joining the two apices.
• a second line is drawn on the heel parallel to the floor.
• the angle formed by the intersection of the two lines indicates the amount of lateral tibial torsion.

POSITIVE SIGN:

• If the hindfoot varus is corrected it indicates the hindfoot is flexible and the hindfoot varus is due to a plantar flexed first ray or a valgus forefoot.
• If it does not correct, the tibialis posterior is tight.

3. Special Test: Tibial Torsion Test PROCEDURE (Prone): 

• knee flexed to 90°.
• the examiner views from above the angle formed by the foot and thigh after the subtalar joint has been placed in the neutral position, noting the angle the foot makes with the tibia. ** ( This method is most often used in children because it is easier to observe the feet from above. )