A 12-month-old with bilaterally asymmetric tibial bowing and a tibial angle greater than 15 degrees. What is the correct action?

• A. Observe the child's condition over time to assess progression
• B. Order physical therapy to prevent progression of symptoms
• C. Reassure the parent that the child will outgrow this deformity
• D. Refer to a pediatric orthopedic specialist for treatment

Answer: (D)

Tibial bowing in an infant can be normal, but when it is bilaterally asymmetric and the tibial angle is greater than about 15 degrees, this suggests a pathologic process rather than benign physiologic bowing. The concern is for conditions like Blount disease (tibia vara), which can progress if not identified early and treated, potentially leading to worsening deformity and leg-length discrepancies. An infant with these findings needs specialized evaluation by a pediatric orthopedic surgeon to confirm the diagnosis and plan management. Imaging and careful assessment will determine whether bracing to slow progression is appropriate or if surgical options become necessary later. Observation or reassurance would risk progression, and physical therapy alone won’t correct a structural bowing deformity.