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Bowed Legs

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Bowed legs also known as genu varum is a bony deformity resulting in outward curvature of one or both knees of the lower legs. It is commonly seen in toddlers and overweight adolescents.

Bowed legs in a toddler is very common knee condition. When a child with bowed legs stands with his or her feet together, there is a distinct space between the lower legs and knees. This may be a result of either one, or both, of the legs curving outward. Walking often exaggerates this bowed appearance.

When your child presents with the above symptoms, your pediatric orthopaedics in Nairobi at NSOC will perform a thorough physical examination and come up with a personalized treatment plan to help your child regain strength.

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Causes and risk factors of bowed legs

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The most common cause of bowed legs is rickets or any condition that prevents bones from forming properly. Skeletal problems, infection and tumors can affect the growth of the leg, which can cause one leg to be bowed.

Arthritis, if it affects the inside of the knee more than the outside can lead to bowed legs, as can a fracture that does not heal properly.

In adults, the most common cause of bowing of the legs is the result of osteoarthritis or wear-and-tear arthritis of the knees.

This condition can wear away the cartilage and surrounding bone of the knee joint. If the wear is evenly distributed, no deformity is expected, but when the wear is more on the inner side of the knee joint, a bow-legged deformity will often progress.

Typically the degree of bowing of the legs corresponds to the severity of the arthritis wearing away the inner side of the knee joint.

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Symptoms of bowed legs

Bowed legs are most evident when a child stands and walks. The most common symptom of bowed legs is an awkward walking pattern.

Toddlers with bowed legs usually have normal coordination, and are not delayed in learning how to walk.

It may be associated with intoeing (inward curvature of the forefoot) and frequent tripping.

Bowed legs do not typically cause any pain. During adolescence, however, persistent bowing can lead to discomfort in the hips, knees, and/or ankles because of the abnormal stress that the curved legs have on these joints.

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Diagnoses of Bowed Legs

When your child presents with the above symptoms, your child’s doctor will perform a thorough physical examination. Symmetric bowing before the age of 2 does not require further testing.

If bowing is more prominent on one leg or your child is older than 2-1/2 years, your doctor will order X-ray and blood tests to identify Blount’s disease or rickets.

A device called a goniometer is used to measure the degree of abnormal bowing.

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Personalized treatment of bowed legs

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Physiologic genu varum. Although physiologic genu varum does not require active treatment, your doctor will want to see your child every 6 months until the bowing has resolved.

Blount’s disease. Infantile Blount’s disease does require treatment for the bowing to improve. If the disease is caught early, treatment with a brace may be all that is needed. Bracing is not effective, however, for adolescents with Blount’s disease.

Rickets. If your child has rickets, your doctor will refer you to a metabolic specialist for medical management, in addition to regular orthopaedic followup. The effects of rickets can often be controlled with medication.

Surgical treatment of bowed legs

Surgery is recommended to correct persistent bowed legs resistant to conservative management. In older patients, the only treatment is surgery.

There are different procedures to correct bowed legs, and they fall into two main types.

  • Guided growth. This surgery of the growth plate stops the growth on the healthy side of the shinbone which gives the abnormal side a chance to catch up, straightening the leg with the child’s natural growth.
  • Tibial osteotomy. In this procedure, the shinbone is cut just below the knee and reshaped to correct the alignment. The bone is held in place while it heals with either an internal plate and screws, or an external frame that is positioned on the outside of the leg.

Following surgery, patients wear braces or casts until the legs heal. Physiotherapy is usually prescribed to regain full range of motion and strength in the legs.

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Bowed legs correction in adults

Adults with severe arthritis most often consider a knee replacement surgery.

However, if the adult is younger, for example in their 20s, 30s, or 40s, they may consider a surgical procedure to realign the bone.

By performing this procedure, called an osteotomy, the forces acting on the knee joint can often be shifted from the unhealthy part of the joint to the healthy part of the joint.

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