Genu varum
| Genu varum | |
|---|---|
| Other names | Bow-leggedness |
Orthopædics | |
Genu varum (also called bow-leggedness, bandiness, bandy-leg, and tibia vara) is a
Causes
If a child is sickly, either with
Childhood
Children until the age of 3 to 4 have a degree of genu varum. The child sits with the soles of the feet facing one another; the tibia and femur are curved outwards; and, if the limbs are extended, although the ankles are in contact, there is a distinct space between the knee-joints. During the first year of life, a gradual change takes place. The knee-joints approach one another; the femur slopes downward and inward towards the knee joints; the tibia become straight, and the sole of the foot faces almost directly downwards.[citation needed]
While these changes are occurring, the bones, which at first consist principally of
Rickets
Nutritional rickets is an important cause of childhood genu varum or bow legs in some parts of the world. Nutritional rickets is due to unhealthy life style habits as insufficient exposure to sun light which is the main source of vitamin D. Insufficient dietary intake of calcium is another contributing factor. Rickets may also have genetic causes, occasionally called resistant rickets.[3] Rickets usually causes bone deformities in all four extremities. Genu varum may resolve spontaneously with modification of life style activities or after receiving medical treatment. Some deformities do not correct spontaneously and need surgical intervention especially if they are severe and causing gait difficulties. The main surgical modality used to treat genu varum arising from rickets is guided growth surgery, also known as growth modulation surgery.[4]
Blount's disease
Blount's disease is a deformity in the legs, mostly from the knees to the ankles. The affected bone curves in or out and forms the usual "archers bow" which can also be called bow-legs. There are two types of Blount's disease. The first type is Infantile: this means that children under four are diagnosed with this disease. Blount's disease in this age is very risky because sometimes it is not detected and it passes to the second type of Blount's disease. The second type of Blount's disease is found mostly in older children and in teenagers, sometimes in one leg and sometimes in both; the patient's age determines how severe the diagnosis is.[5]
Osteochondrodysplasia
Osteochondrodysplasia are a diverse group of genetic bone diseases or genetic skeletal dysplasias that manifest in generalized bone deformities involving the extremities and the spine. Bow legs or genu varum is one of these deformities. The characteristic bone X-ray survey findings are important to confirm the diagnosis.[6]
Diagnosis
On
-
![Hip-knee-ankle angle by age, with 95% prediction interval.[10]](//upload.wikimedia.org/wikipedia/commons/thumb/0/07/Hip-knee-ankle_angle_by_age.png/240px-Hip-knee-ankle_angle_by_age.png)
Hip-knee-ankle angle by age, with 95% prediction interval.[10]
![Hip-knee-ankle angle by age, with 95% prediction interval.[10]](/File:Hip-knee-ankle_angle_by_age.png)
Treatment
Generally, no treatment is required for
Rickets
Rickets usually causes bone deformities in all four extremities. Genu varum may resolve spontaneously with modification of lifestyle activities or after receiving medical treatment. Some deformities do not correct spontaneously and need surgical intervention especially if they are severe and causing gait difficulties. The main surgical modality used to treat genu varum arising from rickets is guided growth surgery, also known as growth modulation surgery.[4]
Blount's disease
Treatment for children with Blount's disease is typically braces but surgery may also be necessary. In children guided growth surgery is used to gradually correct/straighten the bow legs.[11] For teenagers osteotomy or bone cutting is often used to correct the bone deformity. The operation consists of removing a piece of tibia, breaking the fibula and straightening out the bone; there is also a choice of elongating the legs. If not treated early enough, the condition worsens quickly.[12]
Osteochondrodysplasia
Guided growth surgery in children is widely used to achieve gradual correction of knee deformities arising from Osteochondrodysplasia including genu varum. Yet, this treatment is associated with a high incidence of recurrence and repeated surgeries may be needed to maintain proper bone alignment.[11][6]
Prognosis
In most cases persisting after childhood, there is little or no effect on the ability to walk. Due to uneven stress and wear on the knees, however, even milder manifestations can see an accelerated onset of arthritis.[13]
See also
- Genu valgum
- Genu recurvatum
- Varus deformity
- Rickets
- Knee pain
- Knee osteoarthritis
References
- S2CID 36449933. Retrieved 23 July 2021.
- ^ a b One or more of the preceding sentences incorporates text from a publication now in the public domain: Chisholm, Hugh, ed. (1911). "Bow-Leg". Encyclopædia Britannica. Vol. 4 (11th ed.). Cambridge University Press. pp. 343–344.
- S2CID 6146424.
- ^ PMID 32159063.
- ^ Shriner's, Hospital for Children – Houston, TX. "Blount's Disease". Archived from the original on November 26, 2011. Retrieved October 28, 2011.
{{cite web}}: CS1 maint: multiple names: authors list (link) - ^ S2CID 79825711.
- PMID 19995425.
- PMID 24671469.
- PMID 20950695.
- ^ PMID 19797583.
- ^ PMID 31669550.
- ^ PubMed, Health. "Blount's Disease". Retrieved October 28, 2011.
- ^ "Genu Varum". The Lecturio Medical Concept Library. Retrieved 23 July 2021.
External links
- "Bowed Legs". American Academy of Orthopaedic Surgeons.
Reviewed by members of POSNA (Pediatric Orthopaedic Society of North America)