Bow legs

This is a very common condition seen in toddlers. When the legs are brought together then there is a gap at the level of the knee. It happens because of inward bowing of thigh bone or tibia. The deformity may appear to increase on standing.

Causes

1. Physiological genu varus. In most of the toddlers the legs are curved inwards. They should improve over a period of time. The legs should straighten by 2 yrs. The child should be investigated if the deformity is severe, the deformity is only in one leg, if the child complains of pain and if the child appears unusually short.

Gradual correction of physiological genu varum in a child aged 11 month
Same Child at 18 months
Same Child at 2.5 years- Showing correction

2. Rickets. It is a condition in which the bones become weak because of deficiency of calcium, phosphorus or vitamin D. The commonest cause is nutritional deficiency. Children should drink minimum 2 cups of milk every day and should have adequate exposure of sunlight of about 30 min per week.

Radiographs showing features of rickets
Radiographs showing features of rickets

3. Blount’s disease. In this condition the upper part of the growth plate of tibia is abnormal. Hence there is bowing in the tibia. In early stages it is difficult to distinguish this condition from physiological genu varum. This condition is difficult to treat and will need special braces and surgery.

Clinical photo of Blount’s showing bowing in right tibia
Radiograph showing Blount’s disease with medial slope of physis of tibia
MRI picture showing Blount’s disease

Treatment options

1. Medical management. Rickets can be treated with oral administration of calcium and vitamin D Braces. In severe condition in early stages, bracing may be tried to achieve correction.

Use of 3 point brace for correction of genu varum

2. Surgery.
A) Hemi epiphysiodesis (growth modulation). Staples or ‘8’ plates can be used to temporarily stop the growth of one side of the growth plate so that gradual correction occurs over a period of time. It is a small surgery and does not require plaster. The child can be mobilized once the pain decreases.
B) Osteotomy and correction. This is performed in older children in whom the growth has stopped. Bone is cut and an implant is placed to correct the deformity.

Pre Surgery Photograph
Radiograph showing Hemi epiphysiodesis
Post Surgery Photograph