Genu Varum (Bowed Legs)
Physiologic bowlegs is the most common cause of genu varum. It is a physiologic condition that resolves by 2 years of age. However, Blount disease is becoming a more common disorder due to increasing obesity in children.
Differential Diagnosis
- Physiologic
–At birth, normal alignment is 10–15° of varus
–Remodeling of bone resulting in neutral alignment occurs by 2 years of age
- Tibia vara (Blount disease)
–Osteochondrosis of the medial tibial physis, combined with early walking and obesity, leads to compression across the physis that prevents normal growth
–Increased incidence in males, blacks, and obese children
–Infantile tibia vara (1–3 years old) is the most common form, is usually bilateral
–Juvenile (4–10) and adolescent (>11) forms also exist, differing mainly in age at onset, remaining growth, and amount of compressive forces across posterior tibial medial physis
-
Rickets
–Growing bone is inadequately mineralized due to vitamin D deficiency (nutritional rickets) or a defect in mineral metabolism (X-linked hypophosphatemia)
-
Skeletal dysplasias
–Achondroplasia
–Enchondromatosis
–Metaphyseal dysplasia
-
Trauma
–Injury to proximal tibia physis may lead to growth arrest of physeal bar
Workup and Diagnosis
- History
–Parental concern is often the presenting complaint
–Past medical history and associated symptoms may aid
in diagnosis of an underlying cause for bowlegs
- Physical exam
–Plot the child's height on a nomogram
–With patient standing in feet-together position, measure each femoral-tibial angle with a goniometer to quantify the genu varum
–Measurement of the distance between the femoral medial condyles can aid in demonstrating progression or resolution
–Assess tibial torsion (see Intoeing)
- Radiographic evaluation
–In children younger than 2 years of age, plain X-ray may show proximal medial tibial metaphyseal beaking or fragmentation
–In older children, standing, weight-bearing, full-length AP, and lateral X-rays allow for measurement of the metaphyseal-diaphyseal angle
–Measurement of <10° correlates with physiologic bowing, and >16° correlates with Blount disease
- Langinskiold's I–VI stages are used to quantify degree of deformity
Treatment
-
Treatment is based on age and severity
-
Nonoperative
–Bracing is effective in children <3 years old
–50% of patients have a mild form that responds to
bracing
–Trial time 9–12 months before considering surgery
- Operative
–Operative treatment is more likely to be indicated for late-onset tibia vara
–Proximal tibiofibular corrective osteotomy is performed in patients age >4 years old with progressive changes, and age <4 years old who have failed conservative treatment
–Adolescent tibia vara can be corrected with osteotomy or hemiepiphysiodesis to restore normal mechanical axis
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Book Source Details
- Book Title: In A Page: Pediatric Signs and Symptoms
- Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
- Year of Publication: 2007
- Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Leg symptoms
Read excerpts from these other book chapters related to Leg symptoms:
Medical Books Excerpts
- LEG PAIN
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Leg pain
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- Leg Pain
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Leg pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Leg pain
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- LEG PAIN
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Leg symptoms
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More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
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» Next page: LEG PAIN (Differential Diagnosis in Primary Care)
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