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Tibial Torsion...

Discussion in 'General Issues and Discussion Forum' started by Sammy, Sep 10, 2010.

  1. Sammy

    Sammy Active Member

    Members do not see these Ads. Sign Up.
    Right! Now I know it must be here somewhere, but can I find it, No. Can someone please point me in the direction of posts on the treatment of people with tibial torsion. Basically, I've been referred this pt. who'd been in an RTA about 2 years ago. Broke L tib'n'fib among other things. The nice trauma guys did a pretty good job of welding things back together again all things considered, but the foot is now about 15-20 degrees abducted relative to the leg, or, in short, a DIY tib. torsion... The ankle and midfoot aren't too bad but the STJ isn't great. (working on that, though). Am looking for any case studies or experiences as I'd like to do more than just prop the foot up. Any help much appreciated. One pint of the finest ale to the originator of the best (IMO) answer.

    Last edited: Sep 10, 2010
  2. Craig Payne

    Craig Payne Moderator

    "Tibial torsion" is not a diagnosis or pathology. Everyone has "tibial torsion".

    I assume you meant to say excessive external tibial torsion ?
  3. Sammy

    Sammy Active Member

    Ah... yes, sorry about that, perhaps being a little flippant re the use of terminology. Was just giving a general overview in the original post. You're currently No 1 in the list for the free pint by the way.
  4. greatwhite

    greatwhite Active Member

    Hmm. I'm not sure what you are asking. Does this person have any pain caused by altered gait? Are you (or the patient) more concerned about the appearance?

    What is it you are trying to do and why?

    If it's realigning the foot I'd want to know this. Also, if function is adequate for the patients needs and there is no pain I'd be tempted to leave it alone.

    Apart from posting to realign the foot, I can't see another intervention apart from surgery if the bone has been set in that way.
  5. JB1973

    JB1973 Active Member

    hiya Sammy,
    a bit like Greatwhite, i read your post and thought "so what!"
    what do you want to achieve with this patient. is it pain relief? return to a previous sport/function? limit further damage?

    is it wrong to fancy a pint on a monday night:D
  6. Sammy

    Sammy Active Member

    Hi guys, thanks for your replies. Basically, the discomfort in the foot is bearable. The main problem that concerns me is Lower Back Pain. Because the foot is now malfunctioning giving rise to 2ndary shortening of the leg, the pelvis is pretending to be a see-saw and the lower back is whingeing about this sad state of affairs. I (and, I think, the patient) don't really care about aesthetic value - she just wants her life back ie walk without pain. I know how to prop things up and maybe even build a little 'function' into the equation, but I'm looking for something better, something I may have missed. ( I believe in the 'hidden in plain sight' theory). I'd really prefer to avoid any more surgery as would the pt. Fancying a pint on a Monday evening should, at best, be considered inadequate, 4 pints on a Monday is more acceptable as this gives the liver a chance to recover for normal service (5+) on Tues, Wed, Thurs, Fri to build up to the big one where at least 9 pints of IPA will be recycled, after which you then drive home to prepare for the live rock'n'roll show on the Sunday evening.
    You two good guys are currently on half a pint each.
  7. Sammy what you need to do is work backwards....

    Workout what is causing the back pain - Are you sure it´s the new tibial position ?

    If it is workout when and where the new position is causing the stress on the back and then look to see if there is anything you can do without surgical intervention.

    Also you never mentioned if there is a LLD often after surg the is some changes in leg length, so maybe a scanogram to measure the leg length and maybe a consult with your local back person after some back xrays to see whats going on.

    It may not be the new tibial position causing the pain - something to consider.
  8. JB1973

    JB1973 Active Member

    hiya sammy,
    has the patient seen anyone else? ie back pain specialist physio or whatever. could it be SI joint dysfunction? how is muscle strength at the glutes etc, is there tightness anywhere like piriformis? like Michael says, is there any LLD? the excessive tibial torsion may not be the actual problem. did she evr have back pain before the RTA or is it since.
    hope it works out for you. let us know how you get on
  9. Sammy

    Sammy Active Member

    Hi everyone, thanks for all the postings. The patient is still seeing a physio who I hope is working on the muscleature (spelling?) - I've only seen her once and haven't the info. available. There is a small LLD which I hope I can compensate for. The problem is probably a combination of everything - ' the whole is greater than the sum of the parts' - as somebody famous once might have said. I still feel the TT is a major factor. The foot lands excessively abducted and 'pronates' really hard'n'fast to end of STJ rom. You can see the twist'n'shake move up the leg. I'm also sure she lands with the muscles tensed to try to nullify this. Will be seeing her tomorrow (man-flu permitting) for casting and may have the time to find out more then. Probably. God, I need a pint...
  10. physiocolin

    physiocolin Active Member

    Hi Sammy

    Interesting dilemma here. From a physio's viewpoint it sounds very much like the tibiofibular bridge is anatomically malaligned with the talus, creating the asymmetrical status. Measuring the x-ray angle (comparing L and R) should give a fairly clear picture and at two years the remodelling process is pretty much complete.
    Working on various conservative interventions (muscle stretching/lengthening etc.) may be the beginning of a regular repeat process.
    It almost sounds as though the answer may be surgical correction, not what the patient wants to hear but leave that to the advice of the orthopod on the interpretation of the x-rays, but prepare your patient for that possible outcome, then she can decide.

  11. Sammy

    Sammy Active Member

    Hi Colin, thanks for the above. Unfortunately, I share your opinion of the long-term outlook. I've done the castwork (foot looks reasonable) and just have to hope the final device supplied can maintain that position. Will post the outcome on this thread.
  12. physiocolin

    physiocolin Active Member

    I wish you well with the intervention. At the end of the day we all strive to get a result conservatively where pos.

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