Breaking Down Torsional Malalignment Syndrome

• Published in: SN comprehensive clinical medicine 2023-03, Vol.5 (1), Article 112
• Main Authors: Holbert, S. Elliott, Holbert, J. Alexander, Wheatley, Benjamin, Seeley, Mark A.
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Review; Topical Collection on Surgery
• ISSN: 2523-8973; 2523-8973
• DOI: 10.1007/s42399-023-01449-5

Torsional malalignment syndrome (TMS) is a unique condition consisting of structural deformities resulting in lower extremity pain that affects children and adults. The components involved are increased femoral anteversion, increased external tibial torsion, and genu valgum. Treatment for severe deformity for these components is likely surgical and although outcomes are good, treatment is often delayed due to under-diagnosis. Rotational malformations are not typically considered at the forefront of a differential and diagnosis is usually delayed. When patients with severe deformity go undiagnosed, their symptoms will persist, and they may develop other chronic conditions later in life. TMS is an under-recognized complex condition that is out of the typical line of sight for clinicians. Surgical thresholds are difficult to determine due to the variety of methods to measure torsion. Once recognized and accurately measured, good treatment options are available for those with TMS. This topic still requires significant research as many studies fail to examine the condition completely. Future research should focus on evaluating all components of TMS together. This article presents the clinical picture of TMS along with a breakdown of each component (femoral anteversion, external tibial torsion, and genu valgum) that includes diagnostic strategy and a brief overview of treatment options available. Additionally, the article discusses imaging techniques and the biomechanical effects of the condition including its physical and psychological consequences.