Deformity is a general term used to define bends and disfigurations in the bones. Knee area deformities are colloquially known as bowlegs and knock-knees and are the most common cause of consulting paediatric orthopaedics clinic. Apart from that, deformities related to hip and feet are also seen in children.
These deformities shall be examined in detail and differential diagnosis shall be made whether this is a condition observed during normal growth or a condition that requires urgent intervention. For children that form these after birth and generally with walking and for whom we know will recover in the future, no special device use is necessary and monitoring is sufficient. In other, real deformities, problems may arise in the future since load distribution in the knees, hips and ankles is disturbed and they shall be corrected.
Reasons of Deformities
Majority of deformities are congenital. Deformities that manifest after birth are generally accompanied by diseases that disturb bone quality. Most commonly observed is the condition that develops with Vitamin D deficiency also called Rickets. However, the good news is the problem in this group is solved when Vitamin D is given. Surgery is not necessary. In congenital diseases there’s no chance of recovery. The deformity in the legs increases with growth of the child. Therefore measures shall be taken against increased deformity.
Relation of Leg Growth and Deformity in Children
Normal leg growth in children has stages. When they first start walking their legs have bow shape. As their walking speeds up, this view is corrected, completely recovers in 3 years and adult leg shape takes place after age of five. Normal growth continues in this way. Families generally consult the clinic when their child first starts walking and has normal leg curvature. If joints of the children have no problem, child’s general health is fine, child feeds regularly and has no problems related to child growth that draws attention of the paediatrician, family shall be informed and relieved; because thus they will know the leg will completely recover and waiting is enough
Families shall pay attention by checking the distance between the knees when the child joins legs in an attention posture. They can see that gap fall from three fingers to two fingers in six months, for example, and monitor when it is recovering. Families consulting the clinic are explained how to monitor and are asked to make this measurement every three-six months.
A very simple x-ray is taken for diagnosis, parameters related to bone development and metabolism such as calcium and phosphorus are controlled. Blood tests are done for suspected conditions.
Depending on the magnitude of the problem the patients can be directed to paediatric endocrinology or genetics department. These departments work together to evaluate criteria such as whether the disease is congenital and whether it is related to hormone deficiency and treatment is determined in light of such information.
The most important criterion in treatment is age. If the problem will increase as child grows, initially treatments to prevent its progress are used. There are treatments related to correcting crook legs using various orthesis however, their effectiveness has not yet been proven.
Most common practice during childhood is the small plates placed in bone growth areas. These plates correct the bone in the desired manner. This method is easier to apply and less risky compared to hard surgeries such as bone cracking and bone fracture surgeries. When the child is brought late and correction with this method is calculated to be insufficient, cracking the bones for correction are discussed. X-rays are taken and careful examination is done and how the child’s leg will look and what kind of results will be achieved with any degree of correction in any part of the bone is calculated with computers. Treatment program is prepared accordingly.
Sometimes use of such devices create a degree of correction. But this practice is not scientifically proven; yet it can be considered as an alternative if the family is against surgery.
Things to consider after Surgery
Regular monitoring after surgery is very important. Patient is monitored with x-rays and clinical examinations. The most important aspect is the scar treatment, which is applied by the operating specialist. Next step is strengthening the muscles of the child with physical therapy.
Rotational Problems (Twisted inside or outside)
Addition to the all these, there is one more condition called rotational problem. Rotations stemming from the hips are seen more frequently in girls and from the femur in boys. Briefly, when children are walking, the tip of the foot shall slightly point outwards. When foot tips and especially kneecaps look inward, families come to the clinic claiming their child “steps inwardly”. 95% of girls recover automatically. Families shall know that 95 percent of children recover automatically. In girls curve increases until age of 5 and recover between ages five to ten. Only 5% require treatment but frequently it does not require surgery. Recovery is attained with shoes, insoles and various devices.
Briefly it is important that parents do not rush in rotational problems, closely monitor their child and apply correct treatment if necessary.
It is considered for a child above the age of 10 to step outward up to 20 degrees and step inwards up to five degrees while walking to be normal. Stepping inward at angles exceeding these values can create a problem as they may lead to knee pains in the future. Therefore family shall be explained and methods are planned.
Contents of the page are for information purposes only, you must consult your doctor for diagnosis and treatment.