Physiological varus and its timing
A newborn's shins are slightly curved outward, a result of position in the uterus and normal development. As a child begins to walk, the deformity may appear more noticeable because the child spreads his legs wide for stability. Usually by one and a half to two years the axis of the legs is leveled, and then turns into mild valgus. Therefore, in a child under two years of age, symmetrical O-shaped legs without pain, with normal growth and development, do not require treatment - only a routine examination and monitoring of the dynamics is needed.
- In infants, varus is a normal variant
- The axis usually straightens by 1.5–2 years
- Then physiological valgus is formed
- Symmetry of deformation is important
- Assess the child's growth and development
Causes of permanent deformation
The classic cause is rickets, vitamin D deficiency with impaired bone mineralization; bones become soft and deformed under the weight of the body. There are also hereditary forms in which phosphorus is lost, and regular doses of vitamin D do not help. A separate disease is Blount's disease, which affects the inner part of the growth plate of the tibia; it is more common in overweight children who start walking early and is usually asymmetrical. In addition, varus develops after displaced fractures and inflammatory bone lesions.
- Rickets and vitamin D deficiency
- Hereditary forms with loss of phosphorus
- Blount's disease
- Excess weight and early walking
- Displaced fractures and growth plate injuries
- Osteomyelitis and consequences of bone infection
- Skeletal dysplasias
How does it manifest itself?
Parents notice that when the feet are brought together, the knees do not touch, and there remains a noticeable gap between them. The child may wobble, get tired faster, and complain of pain in the legs after a long walk. With rickets, additional attention is paid to thickening in the wrists and ribs, delayed fontanel closure, sweating, anxiety, late teething and short stature. In Blount's disease, the deformity is usually more pronounced just below the knee and is often asymmetrical, and the curvature increases over time.
- The gap between the knees with the feet flattened
- Staggering gait, fatigue
- Leg pain after exercise
- Thickening in the wrists and ribs with rickets
- Short stature and developmental delay
- Increasing deformity in Blount's disease
Survey
The doctor measures the distance between the inner surfaces of the knees with the ankles together, assesses growth according to the age curve, symmetry and gait. In a child over two years old with a persistent or progressive deformity, an x-ray of the legs is taken with a load in a standing position: it shows the axis of the limb and the state of the growth plates, which is necessary to distinguish rickets from Blount's disease. Vitamin D, calcium, phosphorus and alkaline phosphatase are determined in the laboratory; in case of deviations, parathyroid hormone is added and the excretion of phosphorus in the urine is assessed.
- Measuring the distance between the knees
- Assessment of height and symmetry
- X-ray of legs with weight bearing after 2 years
- Vitamin D, calcium, phosphorus
- Alkaline phosphatase and parathyroid hormone
- Assessing urinary phosphorus excretion
- Consultation with an endocrinologist for short stature
Treatment
With physiological varus, treatment is not required: observation, sufficient physical activity and preventive intake of vitamin D are required as recommended by a pediatrician. Confirmed rickets is treated by replenishing vitamin D in therapeutic doses, which are selected by the doctor; hereditary forms are managed by an endocrinologist. For Blount's disease, orthoses are used at an early stage, and when it progresses, surgery on the growth plate or corrective osteotomy is used. Normalization of body weight is important. Orthopedic shoes do not correct the axis of the legs, and you should not rely on them alone.
- Observation for physiological form
- Preventative intake of vitamin D as recommended by a pediatrician
- Therapeutic doses of vitamin D for rickets - only as directed
- Management of hereditary forms by an endocrinologist
- Normalizing a child's weight
- Orthoses for early Blount disease
- Growth plate correction or osteotomy
- Regular examinations by an orthopedist