Deformity Correction

Blount Disorder

Infantile Blount, or pathologic tibia vara, occurs when an abnormal growth plate causes a progressive bowing deformity. X-rays can help differentiate the diagnosis but are not always conclusive in the early stages of Blount. Unlike physiologic bowing, Blount will worsen with time. The long-term consequence of varus alignment is a risk of knee pain and degenerative arthritis. Blount may also occur during adolescence, usually associated with obesity.

Treatment for Bowlegs

Watchful waiting is the only treatment needed for physiologic bowing, as it will improve gradually with time. However, Blount requires treatment and in the early stages is potentially reversible to normal. Leg braces, called KAFOs (knee-ankle-foot-orthosis) are the treatment of choice for children under 3 years old. Unfortunately, braces are not always effective in treating Blount. Due to the abnormal growth plate, there is a risk of recurrence throughout childhood. Surgery may be required for Blount.

Your physician will discuss treatment options which may include a minor surgery called “gui ded growth” (hemi-epiphysiodesis) or bone realignment surgery, termed an osteotomy.

Genu valgus is common in young children, especially after age 3. If knock-knees are present equally in both legs and is not causing symptoms, “physiologic valgum” is the most likely diagnosis. Physiologic valgum is considered normal, but may be a functional or cosmetic concern for kids and parents. Your doctor may order standing full-length X­ rays to measure and monitor your child’s alignment. The majority of children with knock­ knees will improve with time and do not require treatment. Pathologic causes of genu valgum that more frequently need surgery are growth plate disorders and metabolic disease (e.g. Rickets).

In cases of persistent or pathologic genu valgus, the preferred surgical method is “guided growth” (hemi-epiphysiodesis ). It is a relatively safe and simple procedure that will straighten your child’s legs as they grow. Osteotomies, or cutting and realigning bones, are done for severe cases of genu valgum and in skeletally mature adolescents and adults.

Femoral Anteversion

Increased internal rotation of the femur (thigh bone), is called anteversion, and is the most common cause of in-toeing in older children. A child that likes to sit in a “W” position, rather than cross-legged, is a sign of femoral anteversion, but sitting in the “W” position is not known to be detrimental. Parents can be reassured that almost all cases of femoral anteversion improve with time, usually before teenage years and does not cause long term problems.

Internal Tibial Torsion

Increased internal rotation of the tibia (shin bone) is the most common cause of in­ toeing in young children and toddlers. Parents may have concern for their child “tripping over his or her own feet”. Fortunately, tibial torsion is considered a normal variant and there are no long-term consequences. Children typically show gradual improvement before 8 years of age.

Treatment of In-Toeing

Braces and orthotics have not been shown to be more effective than observation alone with in-toeing. For parents with athletically-inclined children, it is reassuring to know that coordination and gait patterns continue to mature throughout childhood. Fun fact: A recent study showed there actually is a high incidence of internal tibial torsion in high­ level athletes and sprinters!

Persistent cases of femoral anteversion and internal tibial torsion rarely require surgical intervention, and indicated only when a child has significant functional problems. Surgery is more commonly needed in pathologic cases of abnormal rotation (e.g. neuromuscular disease, cerebral palsy).

Out-Toeing

Children that walk with their toes pointing outward may cause concern for parents. A common cause of out-toeing is pes planovalgus (“flat foot”), but may be exacerbated by outward rotation of the shin bone, termed external tibial torsion. External hip rotation (femoral retroversion), can also cause out-toeing. Your physician can determine the cause of out-toeing during your exam. Unlike internal tibial torsion, external rotation may not resolve with age. Fortunately, out-toeing often does not require surgery. If your child has symptoms, orthotics or braces may be prescribed. If there are significant and persistent functional problems, surgical correction is an option.

Malalignment Syndrome

This uncommon diagnosis, also referred to as “Miserable Malalignment Syndrome”, occurs when the rotational profile reveals internal femoral rotation with external tibial torsion. The potential consequence is abnormal forces placed across the kneecap (patellofemoral joint), and may lead to knee pain, especially in runners. Conservative measures are taken first to treat Malalignment Syndrome (physical therapy, bracing, and activity modification). Surgery during adolescence can be considered in those patients that do not improve.