Tibia

Rotational deformities in the tibia are fairly common and can have a functional impact on ambulation. Internal and external tibial torsion can both affect gait patterns. In-toeing is often seen in L4/ L5 neurologi­cal levels and is related to muscle imbalances, particu­larly in the hamstrings. The medial hamstring is much stronger than the lateral and may internally rotate the leg. Derotational surgeries should be used only in those who are ambulatory in the community (118).