Presence of symmetrical deformities and absence of symptoms, joint stiffness, systemic disorders or syndromes indicates a benign condition with excellent long-term outcome. In contrast deformities which are asymmetrical and associated with pain, joint stiffness, systemic disorders or syndromes may indicate a serious underlying cause and require treatment.
The most common deformities that would be discussed here are Bow Legs (Genu Varum) and Knock Knees (Genu Valgum).
The Natural History. It is important to note that a newborn initially presents with bow legs. With normal growth, knees gradually become straight by the age 18 months. With further normal development knees gradually drift into valgus (knock knee). This knock knee deformity is maximal at around age 3-4 years. By the age 7 years knee angle (tibiofemoral angle) return to normal adult levels of 5°-7°.
This is well illustrated by the opposite graph (Salenius 1975). The shaded area in light green indicates the 2 standard deviations (SD) from the average. Tibiofemoral angles within this range are considered to be within normal limits.
Treatment is not required for physiological deformities. i.e. deformities within 2 standard deviation or deformities that are not associated sinister features such as pain, asymmetry, stiffness, systemic disorders or syndromes.
Treatment for pathological deformities depends on the underlying disorder and the severity of the deformity.
Metabolic deformities such as rickets could simply be corrected with medical treatment i.e. calcium and vitamin D supplements.
For other deformities, depending on the age surgery in form of corrective osteotomy or partial growth plate arrest (hemiepiphysiodesis) may be needed.
Epiphysiodesis — Osteotomy
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