Torsional malalignment in the lower leg is a common deformity affecting children. Although self-limiting in many patients, it may represent an ongoing cause of gait disturbance, pain, and dysfunction in growing patients. If found to be clinically important, the traditional method in which excessive internal or external rotation of the lower leg is managed is a derotational osteotomy with internal fixation. Controversy exists with regard to the necessity of a concomitant fibular osteotomy to facilitate the necessary correction, with no clear guidelines dictating this indication. If performed, the fibula typically is approached via a second laterally based incision, with dissection subperiosteally. An oblique osteotomy is then performed with the use of a sagittal saw and an osteotome. The location and character of this osteotomy are subjects of debate, with some surgeons being proponents of a transverse osteotomy just proximal to the distal fibular physis and other surgeons in favor of oblique cuts, depending on the direction of correction (anterosuperior to posteroinferior for internal rotational correction and posteroinferior to anterosuperior for external rotational correction). Although single-incision approaches to the lower leg have been described in the literature in patients with traumatic injury and in patients with congenital pseudarthrosis of the tibia, to our knowledge, an anteriorly based incision with dissection that allows for exposure of the tibia and fibula during derotational osteotomy has not yet been described. The goal of this video is to demonstrate the single-incision approach to the tibia and fibula for the management of torsional malalignment.