Massage therapy · Kitchener–WaterlooTibial Pseudarthrosis

Tibial pseudarthrosis is the medical name given to a break in the tibia that has not healed properly. The tibia is the larger of the two bones in the lower leg. Orthopaedic specialists call this failed healing a nonunion (Widmann, 2024). In most cases the condition is associated with neurofibromatosis, a genetic disorder in which tumours grow in the nervous system and under the skin.

The childhood form, congenital pseudarthrosis of the tibia, is very rare – about 1 in 140,000 to 1 in 250,000 (Shah, Rousset and Canavese, 2012). It is not an ordinary broken bone that has failed to heal: part of the tibia develops abnormally, which leads to bowing (bending) of the leg and then a fracture.

Tibial Pseudarthrosis Anatomy

The lower part of the leg is made up of two bones: the tibia and the fibula. The tibia is the larger of the two and carries most of your weight. Children with neurofibromatosis often have a bowing of the tibia toward the front and outside (an anterolateral bow), which may lead to fracture and pseudarthrosis (Widmann, 2024).

Treatments you may want to discuss with your family doctor, nurse practitioner or medical team

Tips

• One specialist estimates that about 90 percent of children heal with these methods (Widmann, 2024), but results vary widely between studies and the bone can break again after healing, so children are followed up until they stop growing (Shah, Rousset and Canavese, 2012).
• If healing is not achieved, a second bone graft may help (Widmann, 2024).
• If you notice a bowing in your little one's leg, have it checked by a medical professional.
• Up to half of children first seen by an orthopaedic specialist for this type of bowing will not yet have a diagnosis of neurofibromatosis, but 80–90 percent will show the condition by the time they are fully grown (Widmann, 2024). Your child's team can explain what this means for them.
• Massage can't change the shape of the bone or help it heal, but once your child's team is happy, I can help with the stiffness, tight muscles and loss of strength that can come with a brace, cast or operation. See the My Approach tab for how I work.

Tibial pseudarthrosis is looked after by your child's orthopaedic team, who decide on bracing, surgery and what your child can safely do. Massage can't change the shape of the bone or help it heal, but I can help with the stiffness, tight muscles and weakness that can come with a brace, cast or operation. After surgery, I need the surgeon's okay before any hands-on treatment.

Please bring any X-ray or scan reports and notes from your child's medical team to the first visit. They're an important part of planning safe treatment for your child.

I assess how your child walks and plays, and check what they've been cleared to do. Parents are welcome to sit in, with your child's agreement.

Keeping It Safe

• No pressure or stretching through the affected part of the shin, since the bone can break again after healing
• Working around any lumps under the skin from neurofibromatosis, and no heat over a metal rod

Supporting Recovery

• Easing the other leg and back, which work harder with a brace, cast or crutches
• Gentle lymphatic drainage for swelling, and scar work once the wound has fully healed
• Setting up crutches or a walker, and practising walking
• Play-based strength and balance work, with home exercises I'll show you how to do with your child
• Care for parents and caregivers too, such as back strain from carrying a child in a cast

1. Widmann, R.F. (2024) Tibial pseudarthrosis: incorrect healing after a pediatric fracture of the lower leg. Hospital for Special Surgery. Available at: https://www.hss.edu/health-library/conditions-and-treatments/tibial-pseudarthrosis (Accessed: 7 October 2026).
2. Shah, H., Rousset, M. and Canavese, F. (2012) 'Congenital pseudarthrosis of the tibia: management and complications', Indian Journal of Orthopaedics, 46(6), pp. 616–626. doi: 10.4103/0019-5413.104184