Presentation
We divided genu varum patients into 3 groups: patients presenting with bow legs before 18 months of age (MOA), patients presenting between 18 and 23 MOA, and patients presenting at 24 MOA or older for analyses relevant to the development of the follow-up [mdedge.com]
Congenital syphilis should be considered throughout early childhood, especially if history of syphilis infection is present. [ncbi.nlm.nih.gov]
Patient complains of pain during walking, standing etc Limp may be present Difficulty in carrying activities of daily living. [blog.portea.com]
Entire Body System
- Pain
The outcomes used to quantify the effect of 6 months (T1), 12 months (T2) and 26 months (T3) of treatment were pain levels, the intercondylar space, the lumbar gibbosity and the lumbar and thoracic Cobb angles. The knee pain disappeared rapidly. [ncbi.nlm.nih.gov]
Pain Pain was measured by the subscale pain of the Knee injury and Osteoarthritisis Outcome Score (KOOS) preoperatively and at the 1 year follow-up [ 15 ]. [doi.org]
Symptoms Symptoms include: An obvious gap between the knees when standing with the feet together Worsening deformity with time if left untreated There is usually no pain Treatment Surgical treatments include: Osteotomy, which is a cut in the bone for [mountelizabeth.com.sg]
Patient complains of pain during walking, standing etc Limp may be present Difficulty in carrying activities of daily living. [blog.portea.com]
- Surgical Procedure
Surgical procedures can be done to place the shin in the proper position and in some cases, lengthen the shin. [web.archive.org]
Surgical procedures. There are different procedures to correct bowed legs, and they fall into two main types. Guided growth. [orthoinfo.aaos.org]
Over time, less invasive surgical procedures, performed in shorter time and with lower complication rates, were created for patients with immature skeleton. [scielo.br]
This surgical procedure thus offers the possibility to study the cross-sectional and longitudinal association of alignment to pain. [doi.org]
- Short Stature
Discussion: - most commonly presents at 14 to 36-months; - bowleg deformity in children w/ short stature & may indicate skeletal dysplasia; - developmental knee alignment: - normal knee alignment progresses from 10-15 deg of varus at birth to maximal [wheelessonline.com]
Short stature and recurrent infections are common. [ncbi.nlm.nih.gov]
Systemic conditions, most of which also result in short stature can also result in genu varum – these include achondroplasia, rickets, renal osteodystrophy and osteogenesis imperfecta. [em-consulte.com]
A family history of short stature or similar varus alignment should be sought; the grandparents may be a good source for this information. [journals.lww.com]
- Fatigue
They fatigue prematurely with activity and do not participate in sports at the level of their peers. Knee problems are very common in children that have knock-knee. Malalignment of the patellofemoral joint is commonly seen, creating imbalance. [southfloridasportsmedicine.com]
This throws considerable strain on the internal lateral ligament of the knee-joint, and after standing of long duration or with undue weight the muscles of the inner side of the limb also become over-fatigued. [en.wikisource.org]
Genu varum induces gait difficulty and aesthetical problems, causing chronic fatigue, spinal deformity, aging, backache, and neuralgia (Kwon, 2002). [jkspm.org]
Affected children complain of fatigue with long-distance walking. Waddling gait may be present. Adult height is either in the lower range of normal or mildly shortened. The limbs are relatively short in comparison to the trunk. [ncbi.nlm.nih.gov]
- Dysostosis
[…] lower limb, pelvis, dactyly Antley-Bixler syndrome - Schmitt Gillenwater Kelly syndrome dactyly Polydactyly/Syndactyly (Webbed toes) - Cenani Lenz syndactylism reduction deficits (Acheiropodia, Amelia, Ectrodactyly, Phocomelia) upper limb (Cleidocranial dysostosis [wikidoc.org]
Metaphyseal dysostosis-intellectual disability-conductive deafness syndrome MedGen UID: 344437 •Concept ID: C1855175 • Disease or Syndrome Metaphyseal acroscyphodysplasia MedGen UID: 344453 •Concept ID: C1855243 • Disease or Syndrome Mesomelic limb shortening [ncbi.nlm.nih.gov]
Musculoskeletal
- Genu Valgum
Published on Aug 6, 2017 Genu varum, Genu valgum, Genu recurvatum 1. GENU VARUM GENU VALGUM GENU RECURVATM PRESENTER: DR. MURUGESH M KURANI Dept. of Orthopaedics, J N Medical College, BELAGAVI. 2. [slideshare.net]
Keywords Genu varum, Genu valgum, Total knee arthroplasty, Lower limb alignment Introduction Genu varum and genu valgum is a specific representation of many diseases with it pathogenesis manifested in internal diseases and surgical diseases. [alliedacademies.org]
The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. (2005) Journal of Medical Science 5(1). 52-54. - ARTICLE A - Normal knee alignment B - Genu Varus (bow legged) C - Genu Valgum (knock-kneed) Why is this relevant [brookbushinstitute.com]
valgum Congenital genu valgum, both sides Congenital genu varum Congenital left genu valgum Congenital left genu varum Congenital right genu valgum Congenital right genu varum Deformity of knee joint, congenital Genu valgum, congenital Genu varum, congenital [icd9data.com]
The mechanical effects of genu valgum and varum deformities on the subtalar joint were investigated. [meridian.allenpress.com]
- Coxa Vara
COXA VARA CONGENITAL ACQUIRED • Defect of endochondral ossification in the medial part of the femoral neck. • Coxa vara can develop if the femoral neck bends or if it breaks. 17. Congenital Coxa Vara. 18. [slideshare.net]
Radiographs show metaphyseal irregularities of the long bones (e.g., splaying, flaring, cupping); shortening of the tubular bones; widened growth plates; coxa vara; and anterior cupping, sclerosis, and splaying of the ribs. [ncbi.nlm.nih.gov]
Neurologic
- Waddling Gait
As it becomes more severe, the patient may exhibit lateral knee thrust and a waddling gait. There may be associated in-toeing and secondary effects on the hip and ankle. [emedicine.medscape.com]
Often the presenting feature is a waddling gait, recognized at the onset of walking. [ncbi.nlm.nih.gov]
- Seizure
0.440±0.898 (108) −0.682±1.023 (38) Height (WHO z-score) −0.721±1.054 −0.024±1.051 <0.0001 Children −0.088±0.964 −0.155±1.101 Adolescents −1.009±1.126 0.106±1.000 <0.0001 Clinical symptoms (%) Bowed legs 15 7 Scoliosis 11 8 Bone pain 8 3 Hypocalcemic seizure [eje.bioscientifica.com]
Workup
Initial pre-referral workup Clinical history Physiologic bowing is the most common cause of bow legs and is seen from birth until two or three years of age. Be aware of pathological causes such as rickets and Blount’s disease. [rch.org.au]
Phosphorous, Alkaline Phosphatase, Calcium, Renal Workup Radiology: Full-Length Scanogram, Physeal Bar Mapping on MRI for Physeal injuries Treatment Medical Treatment plainly for Vit D Deficiency Rickets, Hypophosphataemic Rickets, Renal Osteodystrophy [narayanahealth.org]
Evaluation Gait and rotational profile analysis are important aspects in the workup of angular deformities and help providers to identify the etiology of angular deformities, especially in the pediatric population. [ncbi.nlm.nih.gov]
Treatment
Comparison of Barthel index between before treatment and after treatment. [alliedacademies.org]
Generally, no treatment is required for idiopathic presentation as it is a normal anatomical variant in young children. Treatment is indicated when it persists beyond 3 and a half years old. [en.wikipedia.org]
Despite standard penicillin treatment at the end of the first month of life, it recurred later in life, more than once. [ncbi.nlm.nih.gov]
Nonsurgical Treatment Physiologic genu varum. Although physiologic genu varum does not require active treatment, your doctor will want to see your child every 6 months until the bowing has resolved. Blount's disease. [orthoinfo.aaos.org]
Treatment for Knock-knees Most children with knock knees do not require any treatment, but if the condition persists after age 7, then a night brace attached to an orthopaedic shoe may be recommended. [multnomahortho.com]
Prognosis
These patients have a poor prognosis following high tibial osteotomy. [ncbi.nlm.nih.gov]
Treatment and prognosis The management of genu varum primarily focuses on the treatment of the underlying condition (e.g. vitamin D supplementation in rickets). if conservative therapy (e.g. bracing, splints) fails, surgical management (valgus osteotomy [radiopaedia.org]
[…] tibia vara, which must be differentiated from physiologic genu varum.8-10,15,18-24 The progressive varus deformity of Blount’s disease usually requires orthopedic intervention.1,10,23-26 Early diagnosis may spare patients complex interventions, improve prognosis [mdedge.com]
Yet, this treatment is associated with a high incidence of recurrence and repeated surgeries may be needed to maintain proper bone alignment.[10][5] Prognosis[edit] In most cases persisting after childhood, there is little or no effect on the ability [en.wikipedia.org]
Etiology
Abstract The etiology of genu varum in achondroplasia is the subject of much speculation. The purpose of the current study was to investigate the association between fibular overgrowth and genu varum in achondroplasia. [ncbi.nlm.nih.gov]
Etiology Common causes: physiologic (infants and neonates) rickets (vitamin D deficiency or refractory, caused by hypophosphatemia) bone dysplasia (e.g. achondroplasia) asymmetric arrested growth of the medial distal femur and proximal tibia (e.g. osteomyelitis [radiopaedia.org]
Etiology The recognized etiologies for genu varum include the following: Tibia vara ( Blount disease) – Infantile, juvenile, adolescent (see the first image below) Rickets – Hypophosphatemic, nutritional, renal disease (see the second image below) Tibia [emedicine.medscape.com]
Epidemiology
[…] patella, and rubbing of the knees together as the child ambulates.[2][3] Etiology Bilateral genu valgum Physiologic genu valgum Skeletal dysplasias Metabolic bone diseases Lysosomal storage diseases Unilateral genu valgum Post-traumatic Tumors Infection Epidemiology [ncbi.nlm.nih.gov]
Epidemiology Physiologic genu varum, defined as occurring in children younger than 2 years, is exceedingly common but is self-correcting. [emedicine.medscape.com]
Citation Filho FCG (2017) Epidemiological evaluation of genu valgum and flat feet in the child: experience of the martagão gesteira children’s hospital. Rheumatol Orthop Med 2. DOI: 10.15761/ROM.1000132 [oatext.com]
Pathophysiology
Pathophysiology In normal alignment, the lower-extremity lengths are equal, and the mechanical axis (center of gravity) bisects the knee when the patient is standing erect with the patellae facing forward (see the image below). [emedicine.medscape.com]
Thus, Powers et al [11] and Labotz [12] suggest that a "pathophysiological cascade" occurs where excessive pronation or supination of the foot may lead to an increase in the medial or lateral rotation of the tibia in relation to the femur and, consequently [oatext.com]
Prevention
In some cases, you may be able to prevent certain conditions that cause bowlegs. For example, you can prevent rickets by making sure your child receives sufficient vitamin D, through both diet and exposure to sunshine. [healthline.com]
INTRODUCTION: Intraligamentary correctional operations like a high tibial osteotomy were performed in genua valga to prevent later medial gonarthrosis especially in younger patients. [ncbi.nlm.nih.gov]
When treatment is necessary, braces or surgery can usually fix it and prevent any problems with walking. All A to Z dictionary entries are regularly reviewed by KidsHealth medical experts. [childrensdayton.org]
When treatment is necessary, braces or surgery can usually fix it and prevent any problems with walking. All A to Z dictionary entries are regularly reviewed by KidsHealth medical experts. Translation [connecticutchildrens.org]