Slide 026 — Posteromedial tibial bowing

Clean FRCS notes with inline figures

•On the left is a clinical photo of a baby with left leg bowing with apex posterior

**Fig 1.** Clinical photograph - posteromedial bowing clinical photographtop left

•The ankle is not in a normal resting posture

•On the right is Xray of the patient with tibia and fibular bowing with apex post

•Correlate clinically and obtain AP Xray to see whether the bowing is posteromedial

Diagnosis: posteromedial bowing

•Which is physiological and commonly associated with intra-uterine malpositioning

•It has a benign course, usually will self remodel, do not have syndromal correlation

History and PE

•Multiple pregnancy, oligohydromnios, packaging syndrome (including torticollis, DDH, metatarsal adductus)

•Also check ankle for calcaneovalgus feet

PM bowing vs calcaneovalgus:

•Look for CORA (at distal tibia vs at foot)

•Dorsum of foot touching tibia = calcaneovalgus

•Physiotherapy for stretching

•Monitor for correction and LLD

•Expect LLD ~ 3-4cm

Direct Q&A

Q1 What are the diagnostic findings and management points for Posteromedial tibial bowing?

•On the left is a clinical photo of a baby with left leg bowing with apex posterior

•The ankle is not in a normal resting posture

•On the right is Xray of the patient with tibia and fibular bowing with apex post

•Correlate clinically and obtain AP Xray to see whether the bowing is posteromedial

Diagnosis: posteromedial bowing

•Which is physiological and commonly associated with intra-uterine malpositioning

•It has a benign course, usually will self remodel, do not have syndromal correlation

History and PE

•Multiple pregnancy, oligohydromnios, packaging syndrome (including torticollis, DDH, metatarsal adductus)

•Also check ankle for calcaneovalgus feet

PM bowing vs calcaneovalgus:

•Look for CORA (at distal tibia vs at foot)

•Dorsum of foot touching tibia = calcaneovalgus

•Physiotherapy for stretching

•Monitor for correction and LLD

•Expect LLD ~ 3-4cm

Raw speaker-note hierarchy audit

#	marL	indent	logical	original note line
1	None	None	0	On the left is a clinical photo of a baby with left leg bowing with apex posterior
2	None	None	0	The ankle is not in a normal resting posture
3	None	None	0	On the right is Xray of the patient with tibia and fibular bowing with apex post
4	None	None	0	I would like to correlate clinically and have AP Xray to see whether the bowing is posteromedial
5	None	None	0	Dx: posteromedial bowing
6	None	None	0	Which is physiological and commonly associated with intra-uterine malpositioning
7	None	None	0	It has a benign course, usually will self remodel, do not have syndromal correlation
8	None	None	0	History and PE
9	None	None	0	Multiple pregnancy, oligohydromnios, packaging syndrome (including torticollis, DDH, metatarsal adductus)
10	0	0	0	Also check ankle for calcaneovalgus feet
11	None	None	0	PM bowing vs calcaneovalgus:
12	171450	-171450	1	Look for CORA (at distal tibia vs at foot)
13	171450	-171450	1	Dorsum of foot touching tibia = calcaneovalgus
14	None	None	0	Physiotherapy for stretching
15	None	None	0	Monitor for correction and LLD
16	None	None	0	Expect LLD ~ 3-4cm

lvl

marL

indent

logical

original note line

None

On the left is a clinical photo of a baby with left leg bowing with apex posterior

None

The ankle is not in a normal resting posture

None

On the right is Xray of the patient with tibia and fibular bowing with apex post

None

I would like to correlate clinically and have AP Xray to see whether the bowing is posteromedial

None

Dx: posteromedial bowing

None

Which is physiological and commonly associated with intra-uterine malpositioning

None

It has a benign course, usually will self remodel, do not have syndromal correlation

None

History and PE

None

Multiple pregnancy, oligohydromnios, packaging syndrome (including torticollis, DDH, metatarsal adductus)

Also check ankle for calcaneovalgus feet

None

PM bowing vs calcaneovalgus:

171450

-171450

Look for CORA (at distal tibia vs at foot)

171450

-171450

Dorsum of foot touching tibia = calcaneovalgus

None

Physiotherapy for stretching

None

Monitor for correction and LLD

None

Expect LLD ~ 3-4cm

Improved semantic hierarchy used for the study notes

#	semantic level	section?	rewritten line
1	0		On the left is a clinical photo of a baby with left leg bowing with apex posterior
2	1		The ankle is not in a normal resting posture
3	1		On the right is Xray of the patient with tibia and fibular bowing with apex post
4	1		Correlate clinically and obtain AP Xray to see whether the bowing is posteromedial
5	0	yes	Diagnosis: posteromedial bowing
6	1		Which is physiological and commonly associated with intra-uterine malpositioning
7	1		It has a benign course, usually will self remodel, do not have syndromal correlation
8	0	yes	History and PE
9	1		Multiple pregnancy, oligohydromnios, packaging syndrome (including torticollis, DDH, metatarsal adductus)
10	1		Also check ankle for calcaneovalgus feet
11	0	yes	PM bowing vs calcaneovalgus:
12	1		Look for CORA (at distal tibia vs at foot)
13	1		Dorsum of foot touching tibia = calcaneovalgus
14	1		Physiotherapy for stretching
15	1		Monitor for correction and LLD
16	1		Expect LLD ~ 3-4cm

semantic level

section?

rewritten line

On the left is a clinical photo of a baby with left leg bowing with apex posterior

The ankle is not in a normal resting posture

On the right is Xray of the patient with tibia and fibular bowing with apex post

Correlate clinically and obtain AP Xray to see whether the bowing is posteromedial

yes

Diagnosis: posteromedial bowing

Which is physiological and commonly associated with intra-uterine malpositioning

It has a benign course, usually will self remodel, do not have syndromal correlation

yes

History and PE

Multiple pregnancy, oligohydromnios, packaging syndrome (including torticollis, DDH, metatarsal adductus)

Also check ankle for calcaneovalgus feet

yes

PM bowing vs calcaneovalgus:

Look for CORA (at distal tibia vs at foot)

Dorsum of foot touching tibia = calcaneovalgus

Physiotherapy for stretching

Monitor for correction and LLD

Expect LLD ~ 3-4cm

026. Posteromedial tibial bowing

Clean FRCS notes with inline figures

Diagnosis: posteromedial bowing

History and PE

PM bowing vs calcaneovalgus:

Direct Q&A

Diagnosis: posteromedial bowing

History and PE

PM bowing vs calcaneovalgus:

Raw speaker-note hierarchy audit

Improved semantic hierarchy used for the study notes