Lower Extremity Torsional Deformity as an Overlooked Cause of Gait Dysfunction

CASE: A 15-year-old girl presented with significant right anterior knee pain and a varus-hyperextension gait pattern mimicking knee subluxation. Computed tomography (CT) revealed 44° of femoral anteversion and 35° of external tibial torsion. Magnetic resonance imaging and X-rays failed to demonstrate any abnormalities. Clinical examination supported by CT, EOS, and 3-dimensional gait analysis revealed axial malalignment. Femoral and tibial torsional osteotomies normalized gait, and clinical scores improved. CONCLUSION: This case highlights how torsional malalignment can produce dynamic sagittal and coronal gait dysfunction. Rotational correction resolved symptoms, emphasizing the need to include torsion assessment in patients with unexplained knee pain and gait dysfunction.