Podiatry for Children

What is bowleg?
Bowleg is a term used to describe outward curving of the legs that occurs in almost all children. Also known as genu varum, this is part of normal development. It is actually abnormal for children less than 18 months of age not to be bowleg.

Bowlegs, Knock Knees and the Normal Growth Process
Because of their folded position in the uterus, normal children are born bowlegged. This actually increases until the age of 18 months, and then the legs straighten on their own.
By the time a child reaches age three or four, they develop a knock-kneed configuration, in which their legs angle inwards.
This knock-kneed configuration straightens by about age six, leaving the normal slightly knock-kneed adult alignment. All of this is part of normal development in children, and if your child is on this schedule he/she requires no treatment. We do not use surgery, braces, therapy or special shoes as long as your child is within this normal range

When is Alignment not Normal?
Very occasionally, children can have other problems that result in an abnormal alignment. Some of these problems relate to serious injuries, problems with metabolism or nutrition, or other orthopaedic problems such as Rickets or Blounts disease.
If the child maintains bowlegs after 24 months of age, if the bowlegs are severe or much worse on one side or if other problems are present, we will recommend you see a podiatrist for further evaluation.

How is bowleg diagnosed?
In order to diagnose bowleg the podiatrist must examine the legs and knees. A person with bowleg will have legs that appear farther apart than normal. The distance between the knees while the child is lying on his or her back is a clinical measurement of genu varum. An instrument called a goniometer can be used to determine if the angle of one or both knees is abnormal, and the condition can be confirmed by joint x-rays, although they may not be necessary.  Internal tibial torsion can complicate the bowleg diagnosis. Internal tibial torsion, also known as medial tibial torsion, is an inward twist of the tibia bone (shin bone at the front of the lower leg). This condition can make bowleggedness appear worse than it really
is.

How is bowleg treated?
Again, the huge majority of children with bowlegs are absolutely normal and require no treatment. In unusual circumstances, however, we may diagnose your child with a different problem and recommend   orthotic braces, special shoes, casts, or surgery if their conditions worsen. If bowleg is left untreated, it can cause osteoarthritis or trouble walking as the child ages.

Todays kids and teens are playing sports more than ever before. And with the increased level of sporting activity at ages while the body is still growing, it is not suprising children feel pain. Sometimes parents refer to this as “growing pains” due to its common occurrence and age it occurs. Growing pains can also develop for non-active reasons, such as growth spurts. Growing pain can be felt anywhere but as a podiatrist we commonly see it in the knees, legs, heels.

Although “growing pains” are common, they should not be shrugged off. In fact, these aches are not caused by simple bone growth, as many would believe. Rather, the pains are caused by repetitive stress placed on bones, joints, muscle and tendons. If not treated, it can become worse and lead to other painful areas.

It is important to identify the cause of the pain in order to treat it. Most often, the pain is caused by excessive stress placed on the bone and soft-tissue. Growing pains can be managed y reducing the excessive stress. Some of the common causes of excessive stress are:

• Rolling in too much (‘over-pronation’)
• Tight muscles, such as the calf muscle or hamstrings.
• Weak muscles causing unstable joints.
• Inappropriate footwear for the sporting activity and foot type.
• Insufficient stretching before and after the sports.

If you think your child has growing pains, don’t ignore it. Let the podiatrist do a comprehensive assessment to find the cause and help your child feel better as soon as possible and prevent potential problems long-term.

An intoeing gait affects many children and, as with flexible flat feet, bowlegs, and knock-knees,it falls into the category of physiological problems that occur in normal children. The usual causes are excessive femoral anteversion (hip joint tunred in), internal tibial torsion (leg bone twisted in), and metatarsus adductus (forefoot twisted in). Management is based on understanding the causes and the natural course of the condition and the effectiveness of various treatment modalities.

Intoeing (‘pigeon toes’)
Intoeing is one of the most common conditions encountered with children in podiatry, particularly around the age of two. Although a child can outgrow the in-toeing, it is important to make an early diagnosis of the causes of intoeing to rule out other major medical conditions that may be more serious.

Treatment modalities may also be required to assist in improving the condition depending on the age and severity of the in-toeing. Treatment can involve the use of particular shoes, orthotics, exercises or stretches. The family history also aids the podiatrist in managing the condition.

What is knock knees?
In knock knees, the lower legs bend outward, such that when the knees are touching the ankles are spread apart. Knock knees is also known as genu valgum and is possible in one or both legs.

Normal Leg Development
Most children are born bowlegged and remain that way until about age two or three. At that point, they develop the knock kneed configuration, which persists until about age six. Adolescents and adults are usually slightly knock kneed.

How Is Knock Knees Diagnosed?
There is normally no pain associated with knock knees. It is diagnosed by watching how the child walks and measuring the angle at which the ankles point outward. The podiatrist may also suggest x-rays if an underlying bone problem is suspected.

Cause of Knock Knees
Knock knees usually develops as part of normal growth, but it may also be due to a disease such as rickets or osteomyelitis. Injury to the shin bone can cause knock knees as well. Obesity is an additional risk factor. Sometimes other factors may cause the knock knees to be worse, such as excessively rolling in your feet as you walk.
Knock knees are usually not treated because the child grows out of the condition; certain exercises can make the knee stronger, which helps to stabilize it. Treatment if required depends on the cause of the knock knees, severity, age and other presenting signs.