Bowleg Treatment in Gurgaon, Delhi NCR
Parents of infants and growing children can consult Dr. Ratnav Ratan, a consulting pediatric orthopedist in Gurgaon, Delhi NCR to rule out rickets or Blount’s disease as the cause behind the bowed legs conditions in their child.
Bowlegs refer to a condition in which the legs of the patient are bent outwards, i.e. bowed especially when the ankles are placed together. Bowling of legs is an incorrect alignment of the knees. It is also referred to as genu varum, tibia vara, bowed legs, bowleg syndrome.
What is normal/physiologic
It is normal for an infant to have bowing of legs as they are folded when in the mother’s womb. The infant is likely to outgrow this condition when he or she starts to stand and walk, i.e. up to 2 years of age.
Causes of bowlegs
- Bone Dysplasia
- Blount’s disease
- Paget’s disease
- Rickets
- Lead poisoning
- Fluoride poisoning
- Achondroplasia
- Improperly healed fractures
- Damage to the growth plate
When should parents be concerned?
Usually, by the age of two or three years, the bending of the knees of the child begins towards each other, i.e., inwards. The parents should be concerned if they observe the following conditions
- The angle of the thighbone to the shinbone is not within the normal range
- The direction of the foot vs. the direction of the knees way beyond the normal pattern
- On a comparative analysis, one leg is more bent or curved than the other.
When to consult a Pediatric Orthopaedic surgeon
Along with the reasons mentioned above, the parents should consult a pediatric orthopedic surgeon to prevent their child from developing bowleg conditions in the future.
The pediatric orthopedist will physically examine the child and suggest X-rays and EOS imaging in the standing alignment of the legs ranging from hip to ankle. This helps them to understand the deformity w.r.t. location and extent.
Treatment of Bowleg
Regular observation by the pediatric orthopedist is considered ideal in the initial stages of bowed legs. Also, attempts will be made to correct the angles of the leg through bracing. Surgery is recommended as the last option. The pediatric orthopedist can recommend physical therapy to improve the bowed leg condition before or after the corrective surgery.
Surgical treatments
The pediatric orthopedist will recommend a minimally invasive surgery to assist the guided growth process in the child. Through this surgery, the limb will be directed to grow in a linear direction.
In case of a severe case of bowed legs, osteotomy surgery is suggested. The surgeon will perform an osteotomy on the upper shinbone to correct the alignment of the lower limb.
Role of bracing
Braces work towards pulling the legs into a straighter position at a very gradual pace. The infant or the child has to wear them till the legs are well straightened. Bracing also helps in correcting the leg angles but gradually.
Surgery
Hemiepiphysiodesis temporary arrest – Guided growth
This is a simple reversible procedure with minimal blood loss. The orthopedist arrests the growth of the growth plate present at the end of the long bone. This enables the other side of the growth plate to grow and gradually correct the bowed leg. This entire correction process takes nearly six to twelve months without using casts or braces.
Gradual correction of bowed legs using external fixators
This procedure is recommended for children less than 10 years. The orthopedic surgeon cuts the bone to apply an external yet adjustable frame to the bone using wires and pins. The frame can be adjusted as per the use. Also, the parents are trained on how to use and adjust the frame daily. The child can perform his or her daily activities normally without feeling any discomfort. Regular check-ups and follow-ups with the doctor are necessary to check on the healing progress of the bone.
Acute osteotomy
Acute osteotomy involves a full correction of the bowed leg condition. The bone is cut and a plate with screws is inserted within to stabilize the cut bone. The entire correction procedure takes nearly six to eight weeks while the patient will be immobile during this period to ensure proper correction.
Blounts disease – Why it is important not to miss it early in life
Blount’s disease is usually detected in obese children or children who begin to walk early. It is a type of bowleg deformity that happens at the knee joint or just below it. Blount’s disease condition is identified by severe bowlegs and can affect either one leg or both legs.
It is necessary to detect Blount’s disease early as it helps in proper treatment and management of bowed legs. Patients can develop joint arthritis of the knee and degeneration of the lower limbs.
– Surgical treatment options of Blount’s disease
The two most important criteria for seeking surgical correction of Blount’s disease are –
- Presence of bowed legs deformity in the three years old plus child
- The angle of bowing exceeds 13 degrees as viewed in a standing x-ray of the child’s lower limbs.
The most preferred surgical correction procedures are
Guided-growth procedure
The guided growth procedure is performed on children and teenagers. The pediatric orthopedist arrests the growth of the unaffected growth plate to enable the affected side of the growth plate to grow and catch up with the length of the normal growth plate. The treating surgeon will use small metal plates to prevent the healthy side of the growth plate from growing further.
Tibial osteotomy
This surgical procedure is performed if the patient has attained nearly or full growth and also in cases when guided growth has not delivered desired corrective results.
The pediatric orthopedic surgeon cuts the tibia bone just below the knee joint, realigns it correctly, and supports the bone using a plate or an external device on the leg till the corrected growth is achieved. The leg will grow in a straight line.
External fixators
The pediatric orthopedic surgeon recommends either a single-lane fixator or a circular fixator in conjunction with corrective procedures for other limb deformities. In general, the fixator needs to be worn for at least eight to twelve weeks till the leg deformity is properly corrected.
