Causes and Treatment of Bow Legs & Knock Knees by
Kids Orthopedic
About Bow Legs & Knock Knees Normally, each child’s legs appear bowed till he is two years old. Likewise, a child’s knees appear knocked till he is six years old. But if the child’s legs remain bowed after two
years of age, the parents must start treatment for bowlegs or Genu Varum.
What is Bow legs(Genu varum)? Genu varum (also called bow-leggedness), is a
varus deformity marked by (outward) bowing at the knee, which means that the lower leg is angled inward (medially) in relation to the thigh's
axis, giving the limb overall the appearance of an archer's bow.
Bowleg
Normal Leg
Causes of Bowlegs Infants are born bowlegged because of their folded position in the mother's womb. Bowed legs begin to straighten once the child starts to walk and the legs begin to bear weight (about 12 to 18 months old).
Bowlegs may be caused by illnesses, such as:
1.
Abnormal bone development
2.
Blount disease
3.
Fractures that do not heal correctly
4.
Lead or fluoride poisoning
5.
Rickets, which is caused by a lack of vitamin D
Symptoms of Bowlegs 1. Bowed legs that continue or worsen after age 3. 2. Knees that do not touch when the child is standing with feet and ankles touching. 3. Similar bowing in both legs (symmetrical). 4. Reduced range of motion in hips. 5. Knee or hip pain that is not caused by an injury.
Bowlegs Diagnosis Bowlegs are obvious when a child stands with legs straight and toes pointed forward. Your child's physician can determine the severity of bowlegs by observing the position of a child's legs, knees, and ankles and by measuring the distance
between the knees.
Treatments for Bowlegs in Children
Specific treatment for bowlegs will be determined by the child's physician based on:
1.
The child's age, overall health, and medical history
2.
The extent of the condition
3.
The cause of the condition
4.
The baby's tolerance for specific medications, procedures, or therapies
If bowing of the legs does not correct itself, or increases after a child has been walking for some time, a physician may recommend corrective appliances.
1. Night braces help to pull the legs slowly into a straighter position.
2. Bowlegs caused by an underlying disease cannot be corrected completely until the disease itself is treated. 3. A child usually wears a corrective brace during part of the treatment of the disease.
4. If bowing is severe, your child's doctor my recommend an osteotomy, an operation on the upper part of the shinbone that would correct the lower limb alignment.
What are Knock Knees (Genu Valgum)? Genu valgum, or knock-knees, is a condition where the knees touch but the ankles do not. It
appears most frequently in young children and can be very concerning for parents who may know very little about the condition.
Causes of knock knees Infants start out with bowlegs because of their folded position while in their mother's womb. The legs begin to straighten once the child starts to walk (at about 12 to 18 months).
By puberty, the legs straighten out and most children can stand with the knees and ankles touching (without forcing the position).
Knock knees can also develop as a result of a medical problem or disease, such as: 1. Injury of the shinbone (only one leg will be knock-kneed) 2. Osteomyelitis (bone infection)
3. Overweight or obesity 4. Rickets (a disease caused by a lack of vitamin D)
Symptoms Of Knock Knees A standing child of average weight whose knees touch,
but whose ankles do not, is usually considered to have knock knees. An abnormal walking gait can also be a sign of the condition. The condition usually becomes apparent when a child is 2 to 3 years old, and it may increase in severity until about age 4. It usually selfcorrects by the time a child is about 7 or 8 years old. But if the condition doesn’t appear until a child is 6 or older, it could be a sign that there is an underlying bone disease.
Knock Knees Diagnoses Knock knees become apparent when a child stands with legs straight and toes pointed forward. The child’s doctor can determine the severity of the knock knees by observing the position of the legs, knees and ankles and by measuring the distance between the inner ankle bones. The condition is considered more severe the wider the distance between the ankles.
The doctor’s exam for diagnosing knock knees may include: 1. Measurements of the child’s length and height
2. Measurements of weight and body mass index (BMI) 3. Measurements taken of knee extensions and rotations 4. Assessment of leg-lengths and leg symmetry
5. Observation and assessment of gait
Knock Knees Treatment Non-surgical options for knock knees In a very few cases, the valgus may be complex and may not self-correct. Splints and other devices aren’t usually needed for a child at a natural stage of valgus up to age 7. These devices can be useful if the child’s natural valgus doesn’t straighten out on its own by about the time your child is 7 or 8 years old — or if the valgus has an underlying systemic or metabolic condition causing it.
For children with severe, unresolved knock knees, doctors may recommend: 1. A night brace, particularly if a family history of knock knees exists, the brace attaches to a shoe and
works by pulling the knee up into a straight position. 2. Orthopedic shoes, usually equipped with a heel wedge and occasionally an arch pad.
Surgical options for knock knees In the rare event that natural growth, braces or shoes don't correct your child's knock knees, your doctor may recommend surgery. The surgery may involve either influencing bone growth or cutting and straightening the thigh bone or shin bone. Guided growth surgery means stopping the growth on the
bent side of the bone (for knock knees, the inside of the knee). This is often done by implanting small metal devices that tether the medial/inside part of the growth centers
around the knee, allowing the lateral/outer part to grow and straighten the knee.
Children usually have guided-growth surgery when they're approaching puberty (approximately age 11 in girls and 13 in boys). This allows time for the child's bones to continue to straighten on their own during the remaining growing years. This is a minimal daysurgery procedure with immediate weight bearing and a rapid return to sports allowed.
Osteotomy surgery is required for complex deformities or after growth
is finished. After surgery, the child will probably stay in the hospital for a couple of days and be given pain medication. When the child goes home, limit weight-bearing activities. Crutches or a walker may be
needed for a six to eight weeks. Physical therapy will help restore muscle strength. Typically, after six months, full activities, including sports may be resumed.
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