Bow legs, medically termed genu varum, describe a condition where an individual’s legs appear to curve outwards at the knees, creating a noticeable gap when standing with the feet together. This condition is frequently observed in infants due to their confined position in the uterus before birth, and often resolves naturally as they grow. This article explores the assessment of bowed legs and various treatment approaches.
Identifying Bowed Legs and Their Causes
It is important to distinguish between “physiological bowing” and “pathological bowing.” Physiological bowing is a normal developmental stage, particularly common in infants and toddlers, and typically corrects itself without intervention by the age of two to three years. If bowing persists beyond this age, or if it is severe, asymmetrical, or accompanied by pain, it may indicate pathological bowing.
Pathological bowing necessitates medical attention and stems from various underlying causes. Rickets, a bone growth problem, is a common cause, resulting from insufficient vitamin D or calcium, which weakens bones and can lead to leg bowing. Another cause is Blount’s disease, a growth disorder affecting the growth plates of the shin bone (tibia). This condition causes the lower leg to angle inward and can worsen over time if left untreated. Less common causes of bowed legs include metabolic bone diseases, such as osteomalacia, or improperly healed fractures. A professional diagnosis is crucial to determine the specific cause and severity of the bowing.
Non-Surgical Treatment Options
For cases of physiological bowing, watchful waiting and regular monitoring are the primary approaches. Doctors often recommend periodic examinations to ensure the bowing resolves naturally as the child develops.
For specific conditions like Blount’s disease in young children, orthotics or braces, such as Knee-Ankle-Foot Orthoses (KAFO braces), may be used. These devices are designed to guide bone growth and can be effective, especially when initiated early. However, bracing is generally not effective for adolescents with Blount’s disease.
Nutritional interventions are crucial for bowed legs caused by Rickets. Increasing intake of vitamin D and calcium through diet or supplements can help strengthen bones and correct the bowing. Depending on the severity, nutritional rickets can improve within weeks to several months with proper dietary management. Physical therapy serves as a supportive measure, focusing on strengthening muscles, improving balance, and correcting posture, though it rarely serves as a primary solution for structural bowing.
Surgical Correction Procedures
Surgery becomes an option for bowed legs when cases are severe, when non-surgical treatments have not been successful, or for older children and adolescents. Surgical intervention aims to correct alignment, alleviate pain, and prevent future joint complications.
One procedure is Guided Growth, also known as Hemiepiphysiodesis. This minimally invasive technique involves temporarily placing small plates or screws on one side of a growth plate. This slows growth on the tethered side, allowing the other side of the bone to continue growing normally and gradually straighten the leg over time. Guided growth is effective in children who are still growing, as it harnesses the body’s natural growth process for correction.
Another common surgical approach is Osteotomy, where a bone, frequently the shin bone (tibia) or thigh bone (femur), is cut and realigned. After the bone is repositioned into a straighter alignment, it is secured with internal fixation devices like plates, screws, or rods. This procedure is often used for more severe deformities or in patients who are no longer growing.
Post-Treatment Care and Monitoring
After treatment, a structured recovery process is necessary. Rehabilitation, including physical therapy, is important to help patients regain strength and restore range of motion in the affected limb. This therapy often includes exercises to improve balance and stability.
The use of casts or braces may be required post-surgery to stabilize the limb and support healing. Pain management is a component of post-operative care, with medication prescribed as needed. Long-term follow-up appointments with an orthopedic specialist are important to monitor the healing process, confirm the correction is maintained, and check for any potential recurrence or growth-related issues, especially in children.