Tibial Torsion in Children of the Jeju Area

Song, Dong Ho; Eun, Baik Lin; Park, Sang Hee; Lee, Joon Young; Tockgo, Young Chang

Abstract

PURPOSE
Internal tibial torsion is prevalent in East Asian countries such as Korea and Japan, where sitting on the floor is common behavior. Internal tibial torsion or excessive lateral tibial torsion may cause esthetical, functional, or psychological problems and also may induce degenerative arthritis in older age. The purpose of this study is to measure the tibial torsion in children of the Jeju area.
METHODS
Tibial torsion was measured in 1,042 lower extremities of 521 children from one to 12 years of age. The values of transmalleolar angles were analyzed for each age group divided by 6 months. Quadratic and linear regression models were used to fit patterns of changes in mean values of transmalleolar angles. The age at seven, which provides the highest coefficient of determination for quadratic regression analysis, was used as a cut-off point to fit different statistical models.
RESULTS
The mean transmalleolar angle was 0.10+/-5.79degrees in all children, 0.90+/-5.49degrees in males, and -0.80+/-5.97degrees in females. The value was 4.25+/-4.04 in 1 year of age, gradually decreased to the lowest level of -1.98degrees in four years and seven months of age, increased again with age until it reached 0.67+/-1.10degrees at seven years of age, and stayed at that level thereafter.
CONCLUSION
Internal tibial torsion in infancy is known to correct spontaneously in the normal developing process. But in this study, the mean transmalleolar angle in children of Jeju area annually decreased after one year of age; to the lowest angle at four years and seven months of age; increased again gradually to the age of seven; and persisted in that level, about 10degrees less than western children, not correcting further thereafter. These findings suggest tibial torsion might be caused by lifestyle, especially sitting on feet. To prevent abnormalities of joints and gaits, early diagnosis of tibial torsion in childhood and posture correction or early treatment when needed, seems to be necessary.