Standing anteroposterior films of both lower extremities help distinguish physiologic bowing from pathologic causes. Tibial metaphyseal-diaphyseal (MD) angles are typically 11 degrees or less. A similar angle constructed in the distal femur is the same or greater, indicating that the femur and tibia both contribute to the bowing. The ratio of femoral to tibial MD angle is greater than 1.
Reproduced with permission from: Schoenecker PL, Rich MM. The Lower Extremity. In: Lovell and Winter's Pediatric Orthopaedics, 6
th ed, Morrissy RT, Weinstein SL (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. Copyright © 2006 Lippincott Williams & Wilkins.
www.lww.com.
