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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Bow Legs

BOW LEGS

Bowed legs, otherwise known as genu varum, is very common in toddlers. Most children below the age of 2, show bowing of the legs as a normal variation in leg appearance. This type of bowing is referred to as physiologic genu varum. At 18 months of age, the bowing gradually starts to improve and usually continues to do so, as the child grows. By age 3 or 4, the bowing has resolved naturally and the legs have a normal appearance. When children with bowed legs stand with their feet together, there is a significant distance between their lower legs and knees. Walking may make this bowed leg appearance more pronounced. Bowed legs may be the result of one or both legs curving inwards. Bowed legs occasionally occurs in adolescence and in many of these cases, the child is significantly overweight (AAOS, 2005-2011).

Causes:

1) Physiologic genu varum or a slight amount of bowing of the lower legs and feet, is normal in infants and young children, due to the squatting position in utero.

2) Pathologic bowing is caused by some disease process that affects bone growth. For example, Blount's disease (tibia vara) is a known cause of bowing of the legs. This condition usually begins before the age of 5 and involves an abrupt deformity at the top of the lower leg just below the knee. Pathologic bowing tends to get worse over time without treatment. The cause of Blount's disease is unknown, but there is possibly a mechanical cause because the condition tends to happen more frequently in obese children who walked early. Females and short children, are also more prone to developing this disorder. Rickets is a disease that affects the metabolism of vitamin D. Vitamin D is vital for bone mineralization. This disease process has been implicated as one of the causative factors in the development of bowed legs. Other causes of abnormal bowed legs include; skeletal abnormalities, tumour, infection and physical trauma (kidsgrowth.com, 2011; suite 101.com)

Symptoms:

Symptoms most commonly associated with bowed legs;

* The knees don't touch when standing with the feet together

* Excessive tripping

* In-toeing (walking with the toes turned in)

* Knock knees

* Bowing of the legs is the same on both sides of the body (symmetrical)

* Bowing of the legs continues beyond age 3 (Children's Hospital Boston, 2005-2010; NY Times, 2011).

Diagnosis:

Bowed legs are evident when a child stands with their legs straight and their toes pointing forwards. Your doctor will ascertain the severity of the bowing by; observing the position of your child's legs, knees and ankles and by measuring the distance between their knees. The degree of internal rotation can be established by observing your child while walking, both coming and going. Information regarding family history, birth injuries and nutrition will also be required (Children's Hospital Boston, 2005-2010).

X-rays are helpful in documenting the degree and location of the bowing, as well as for detecting any underlying bone deformities. X-rays are unable to distinguish between Blount's disease and physiologic bowing, if your child is under 15 months of age. Blood tests may be performed to check for vitamin deficencies (Children's Hospital Boston, 2005-2010).

Treatment:

There are both normal and abnormal instances of bowing. Therefore, treatment may vary among patients according to the cause (suite, 101.com). 

For most children, physiological bowing corrects itself with normal growth and development. Allowing your child to stand up before they are able to walk, will not cause bowed legs. Standing stimulates the legs and helps them to straighten (chw, 2005-2011; Leary, 1990).

No treatment is indicated for bowed legs; unless the deformity is severe, progressive, or the result of an underlying medical condition. Your child should be reassessed on a 6 monthly basis. If the bowing is extreme, special shoes may be recommended, that rotate the foot outwards with an 8-10 inch bar between them. However the effectiveness of these shoes is still unclear (kidsgrowth.com, 2011).

Bowing as a result of a skeletal deformity, bone disease or trauma, may require immediate medical intervention. Severe bowing before the age of 3, may be partially corrected with a brace to assist in straightening the bone, and to allow the child to grow before resorting to surgery. Surgery is a last resort treatment because it requires 2 months recovery time and may be traumatic for the child. Physical therapy post-operatively is essential. Occasionally, if severe bowing continues into adolescence, surgery is performed to correct the deformity (A.D.A.M, 2011; suite 101.com).

If the bowing is pathologic and the result of some underlying disease process, that particular condition needs to be identified and treated. Generally, Blount's disease requires a combination of wearing a brace, known as a knee-ankle-foot orthosis(KAFO) designed to prevent knee flexion, and surgery. The aim of surgical intervention is to rotate the shin bone into its proper position, so that the child does not develop disabled knee joints later in life. Nutritional rickets is treated with large doses of vitamin D, dietary changes and possibly light therapy. This exposes the patient to ultraviolet rays or sunlight which gives vitamin D. Alternative therapies, such as acupuncture, chiropractics, massage, etc. may be helpful (Medical Care Centre, 2011).

Prognosis:

Physiological bowing generally corrects itself and bowed legs will not interfere with your child's ability to lead a normal life. However, in severe cases, that are left untreated, arthritis and an awkward gait may become problematic later in life (rogerkapp.com, 1997).