Tibiotalar tilt--a new slant.

Classically tibiotalar tilt (TTT) is associated with four conditions: Fairbanks disease, hemophilia, sickle-cell anemia and juvenile rheumatoid arthritis. We have found it to be present in at least 20 other conditions including other dysplasias, developmental conditions such as fibrous dysplasia and a variety of other acquired disorders including various metabolic diseases and following previous trauma. The pathogenesis is controversial, but the most probable cause is related to stress and the blood supply of the distal tibial epiphysis. The differentiation of TTT from pseudotibiotalar tilt is also discussed.