Standing anteroposterior films of both lower extremities help distinguish physiologic bowing from pathologic causes. This patient with X-linked hypophosphatemic rickets (XLH) has multiple widened physes. Osteopenia is evident in the adjacent metaphysis, which is also flared. Bowing tends to be more diffuse throughout the bone, rather than focal in the proximal tibia.
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.
