Summary Posteromedial Tibial Bowing is a congenital condition thought to be a result of intrauterine positioning that typically presents with a calcaneovalgus foot deformity and leg length discrepancy. Diagnosis is made radiographically with xrays of the tibia. Treatment is observation for bowing deformity which usually spontaneously corrects over 5-7 years. If leg-length discrepancy develops, nonoperative or operative management may be indicated depending on the severity of the discrepancy. Epidemiology Anatomic location usually involves middle and distal third of tibia Etiology Genetics no known genetic association Associated conditions calcaneovalgus foot posteromedial bowing is often confused with calcaneovalgus foot, another condition caused by intrauterine positioning the two conditions may occur together or independently of each other Presentation Symptoms presents at birth Physical exam posteromedial bowing apex of deformity is in the distal tibia calcaneovalgus foot deformity apex of deformity is at the ankle Imaging Radiographs recommended views AP and lateral of tibia findings will see posterior medial bowing Treatment Nonoperative observation indications observation is indicated for bowing deformity which usually spontaneously corrects over 5-7 years make sure to follow clinically to monitor for leg length discrepancy associated calcaneovalgus foot treated with observation and parental stretching Operative age-appropriate epiphysiodesis of long limb indications projected leg length discrepancy > 50% of patients end up requiring surgical intervention for LLD Complications Leg length discrepancy patient may have residual 2-5 cm leg length discrepancy at maturity may require age-appropriate epiphysiodesis of long limb Prognosis Sequelae Most common sequelae of posteromedial bowing is average leg-length discrepancy of 3-4 cm