Radiographic evaluation of bowed legs in children

Jon Davids, Dawn W. Blackhurst, Benjamin L. Allen

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Radiographic screening is widely used to distinguish between Blount disease (infantile tibia vara) and physiologic bowing. Thirteen children with Blount disease, evaluated before 3 years of age, with initial radiographs showing no sign of Langenskiold changes, were compared with 50 children with physiologic bowing, also evaluated before 3 years of age with similar radiographic studies. Screening test accuracy was determined retrospectively for measurement of the mechanical axis, the tibial metaphyseal-diaphyseal angle (TDMA), and the epiphyseal-metaphyseal angle (EMA). A radiographic screening method combining the TMDA and the EMA, using cutoff values of 10° and 20° respectively, exhibited the best combination of sensitivity, specificity, and positive predictive value, correctly identifying all cases of Blount disease and 40 of 50 cases of physiologic bowing. Our data suggest that children between 1 and 3 years of age with TMDA <10°, or TMDA ≥10° and EMA ≤20°, are at less risk for development of Blount disease. Children with TMDA ≥10° and EMA >20° are at greater risk for development of Blount disease and should be followed closely.

Original languageEnglish (US)
Pages (from-to)257-263
Number of pages7
JournalJournal of Pediatric Orthopaedics
Issue number2
StatePublished - 2001
Externally publishedYes


  • Epiphyseal-metaphyseal angle
  • Infantile tibia vara
  • Radiographic screening
  • Tibial metaphyseal-diaphyseal angle

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Orthopedics and Sports Medicine


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