Synonyms

Medical: Genu varum

English: bowleg, out knee, genu varum

definition

The If one count to the misalignments of the axes. These are deviations from the normal axis. Bow-legs are characterized by the fact that the axis deviation of the legs is directed laterally outwards. Viewed from the front, the deformity gives the impression of an "O".

Specialty

The If a in infants and newborns is part of normal development. If the body does not straighten up in the following development period, the O-shaped legs also remain. However, there is a high rate of spontaneous correction in children with bowlegs.

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causes

Bow legs can be congenital (see above) or acquired.

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Congenital bow legs

At the beginning of every life (until the end of the 2nd year of life) bow legs are completely normal. All babies and toddlers naturally have bow-legs (Genu varum). However, these regress at the latest in the course of the third year of life and are even tilted to the other extreme for some time in the course of natural skeletal development, to knock knees (genu valgum). With unphysiological knock-knees, a surgery be performed. From around the age of 10, the normal leg axis is largely fully aligned.

Bowlegs can also be symptoms of congenital connective tissue weaknesses or systemic diseases.

Acquired bow legs

1. Acquired bow legs can be symptoms of various underlying diseases:

  • Rickets (vitamin D deficiency)
  • Hormonal imbalances
  • Bone fragility (osteoporosis) after the Menopause
  • Overload (for example by Obesity)
  • Inflammation
  • tumor
  • Trauma (e.g. broken bones)

If strong bow-legs appear in childhood and persist, it is common rickets to find the cause. Rickets is a bone growth disorder caused by a Deficiency in vitamin D and calcium arises. This leads to poor bone mineralization, the growth plates are restructured and the long bones are deformed.
In the industrialized countries a supply of the most important minerals is mostly guaranteed, so it is with a balanced diet a lot of fruits and vegetables, such as healthy oils (cold-pressed linseed oil, olive oil) does not lead to a deficiency in children. Additionally promotes a moderate stay in the sun (Attention, absolutely avoid sunburn!) To an adequate supply of vitamin D.

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But bone diseases other than rickets can also lead to bowlegs. Here come the so-called Achondroplasia, the Osteogenesis imperfecta, but also tumors or accidents (trauma) as possible causes. Especially when the growth plates of the bones are affected by these influences, there can be a shift in growth, causing the axis to straighten up "crookedly".

2. Even with paralysis, bow legs can arise if by one asymmetrical muscle pull the direction of growth is changed.

3. It is also possible to have bow legs completely innate are and also one-sided training in adulthood, it can still cause a subsequent misalignment of the leg axis and thus lead to bow legs.

Some sports promote bow-leggedness. These are mainly sports in which the muscle group is called the Adductors on the inside of the thigh is more demanding during training and is therefore trained more than the external abductors. The best-known example of this is soccer. Paralysis, which then leads to a muscular imbalance, can also cause bow-legs.

Symptoms

Generally speaking, pain occurs primarily. Due to the misalignment of the legs, there is constant improper strain on the Knees.
In the case of bowlegs, the inside of the knee joints in particular are stressed. This leads to increased and, above all, early wear of the knee joint on the inner side.
Especially the sufferers here meniscus (esp. the inner meniscus) and the cartilage. Problems do not only arise in the knee joint.

Also Buckle feet can train. This also serves to compensate for the misalignment of the legs. Of the Foot kinks outwards so that the inside of the foot points too far down. During the clinical examination of the knee joint, tensile and pressure pain, especially of the outer ligament, and typical symptoms of a arthrosis (Joint effusion, rubbing in the knee joint, pain from movement and exertion) can be determined.

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Is the so-called Genu varum only one-sided, this can lead to a lateral inclination of the pelvis Spine come to compensate for the pelvic inclination.
Because of these deformities, children need to see a doctor (preferably a specialist in Orthopedics) to be introduced.

Diagnosis of bow legs

The diagnosis is of course made clinically in pronounced forms. The misalignment can be easily recognized from the outside without any problems.
For lighter forms, the X-ray be helpful. Here are the Thigh bone, the knee joint to the Ankle joint X-rayed in a so-called axis recording.
In order to objectively record the extent of the deformation, an imaginary line is drawn from the Femoral neck of the thighbone pulled through the knee joint to the ankle.
Normally this line goes right through the knee joint.
With bow legs, this connecting line hits the knee joint too far inside, i.e. towards the other leg. Another diagnostic option is through a Running analysis.

therapy

Infants and children often have bow legs that "grow together" as they develop.

The therapy bowlegs strongly depends on the age of the patient, also on their causes and the extent of the deformity. In infancy, bow legs are part of normal development. An excessive degree of misalignment is often based on one Bone growth disorder (rickets) by Vitamin D deficiency or one Disruption of calcium absorption in the intestines. The therapy therefore consists of one high-dose calcium or vitamin D administration.

Conservative therapy

If the knee misalignment is only slightly pronounced, it is possible conservative, i.e. non-surgically, to be treated. Usually come individually adapted shoe insoles for use. This is ultimately about wedge-shaped elevations on the outer edges of the shoe, whereby the knee forced into a position tilted towards the center, thereby straightening the leg axis as a whole. Especially in children, but also in adults, wearing these insoles every day for many years promises good therapeutic success. This therapy is then often supplemented by physiotherapy exercises.

Invasive correction

Since there is a risk of severe and painful long-term damage (signs of wear and tear) to the knee joint, conservative therapy is recommended for more pronounced bow legs (Genu varum) mostly no longer sufficient.

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A surgical procedure, the so-called Corrective osteotomy is necessary in order to be able to permanently correct the misalignment of the leg axis. The tibia is severed and the leg is brought into a straight position by removing a wedge-shaped piece of bone on the outside of the tibia or by spreading the end of the bone on the inside of the bone. Titanium plates and screws stabilize the shin bone. The separated bone ends grow together without scars in the next months to years.
A full load on the leg is possible again after about 3 months.

Read more on this topic at:

  • Bow-leg therapy
  • OP on bow legs

prophylaxis

In addition to avoiding the underlying diseases or other triggering factors, unfortunately the development of the If one cannot be prevented.

forecast

After the operation, a hospital stay of around 7 days is usually scheduled. A partial burden of the bone from the beginning is not only allowed, but also important to strengthen the bone structure.
After 6 weeks at the latest - depending on the x-ray findings - the leg is fully loaded again. To accelerate healing and strengthen the leg should physiotherapy Many patients go about their everyday life after about 2 weeks on crutches relatively unrestricted.

Exercise can also be done by the patient. In the beginning, however, no too strenuous sports. So, for example swim on.

Problems with bow legs

In the long term, all higher-grade leg malpositions, whether knock knees or bow legs, lead to one premature wear of the articular cartilage, so that with increasing age with a Gonarthrosis (Knee osteoarthritis) must be expected. In the case of the knock knees, the outer knee joint is particularly affected, while with bow legs an internal knee osteoarthritis comes into play.
However, the extent of osteoarthritis depends on other risk factors such as Obesity, Connective tissue weakness, accident and injuries etc.

Bow legs in babies

As the child grows, their lower extremities go through some development. Already at birth, but at the latest when starting to walk, every child has an O-shape of the legs (Genu varum). Over the next few years (mostly until about 3rd year of life) will compensate for this and the legs will take on a straight shape (Genu rectum), as it can also be found in healthy adults. During the following years, however, the previously found “misalignment” of the bow legs will reverse into the opposite, it will develop Knock knees (Genu valgum) out. These in turn are up to about 10th year of life disappear, so that the child until the entry of the puberty should have a straight leg axis.

In contrast, very pronounced or increasing bow legs in newborns and infants require observation. In most cases, however, this deformity is also benign and grows together over the years. It can still be helpful if you use the Document the development of your child's legs with photosso that the treating pediatrician can always understand the development.

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Read much more information on this topic at: Bow legs in babies

Bow legs in adulthood

Uncorrected misalignments of the Joints can lead to sometimes serious complaints in the long run. Since with bow legs the inner parts of the Knee joints, more precisely the inner thigh hillocks, are more heavily loaded than the outer ones, they wear out over the years. This encourages the creation of a arthrosis, in this particular case centered Knee osteoarthritis (internal gonarthrosis), which then comes into play at the latest in old age. Stand at the beginning of this clinical picture Starting pain and a recurrent inflammatory activations of osteoarthritis of the knee. The already existing misalignment of the knee will increase further as a result of the increasing wear and tear of the inner joint surface and can sometimes assume grotesque forms with age.

Summary

If one are deviations of the normal straight leg axis laterally outwards. Bow legs can be both congenital and acquired. Especially with newborns and infants, bow-legs are completely normal and spontaneously regress.
Among other things, trauma can be acquired. Complaints include pain, which is usually caused by a arthrosis and uneven wear of the Knee joint evoked. If the bowleg occurs only on one side, the body can also curve the Spine form.
The therapy is based on the causes and can range from treating the underlying disease to surgery pass. Depending on the severity of the disease, the method of surgical therapy must ultimately be resorted to. These cases come with a good prognosis.
The patients must, however, strictly adhere to the doctor's instructions regarding the permitted exposure.


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