LIMB DISORDERS

LEG PAIN:

Diagnosis/What to look for:  
Not every bump, bruise or complaint of pain warrants a trip to the doctor.  However, if your child’s leg pain has any of the following features, you should seek prompt medical attention:

  • Pain that wakes him or her from sleep
  • Pain associated with a fever
  • Pain associated with swelling, redness or warmth
  • Pain associated with limping
  • Unexplained pain that lasts for more than a week

Treatment:  
The treatment of leg pain is entirely dependent on what is causing the pain and can range from brief periods of rest or activity modification to surgical intervention.

TORSION (IN-TOEING/OUT-TOEING):

Torsion is a descriptive term that is typically used when a child’s limb displays an “abnormal” amount of rotation, usually resulting in in-toeing or out-toeing.  What defines an abnormal amount of rotation depends on a variety of factors such as the age of the child and the part of the limb that is affected.     Because there is a wide range that constitutes “normal”, in the vast majority of cases, the rotational abnormality does not reflect a true abnormality at all, but is a variation of normal.

Diagnosis/What to look for: 
As a child grows from infancy to adolescence, his or her limbs undergo a normal progression from internally rotated and bow-legged  at birth, to slightly knock-kneed and externally rotated in early childhood, to the “normal” amount of rotation in adolescence.  Cause for concern arises when one limb is significantly more rotated than the other and should be further investigated by your physician.

Treatment:
Because most cases of torsion are not actually abnormalities, they tend to correct themselves as the child grows and develops.  Surgical intervention is necessary only on rare occasions.

GENU VARUM (BOW-LEG DEFORMITY)

Genu Varum or bow-leg deformity refers to outward bowing of the lower extremities. It is commonly associated with in-toeing.

Diagnosis/What to look for:
Bow-leg deformity is a relatively normal finding in infants and toddlers up until the age of two years, after which time its presence should be investigated (by a pediatric orthopedic surgeon) to rule out a pathologic cause.  Pathologic bowing may be due to a number of processes such as Blount disease, metabolic bone disease or tumor, the most common of which is Blount disease. A simple x-ray is often all that is necessary to differentiate between pathologic and physiologic bowing.

Treatment: 
Physiologic bowing requires no treatment as it is expected to resolve completely as the child grows. The treatment for pathologic bowing depends on the nature of the pathologic process and may range from correction of nutritional deficiency to surgical intervention.

BLOUNT DISEASE

Blount disease is a form of pathologic bowing of the tibia (lower leg bone) that is caused by a growth disturbance in its upper end (proximal tibia). It can occur in very young children (ages 2-4) and in adolescents. It is more common in children and adolescents who are overweight and in early walkers.

Diagnosis/What to look for:

Bow-leg deformity in a child over the age of two should be thoroughly investigated by your pediatric orthopedic surgeon. Adolescent patients with Blount disease often complain of knee pain in addition to increasing bow-leg deformity.

Treatment: 
Bracing may be effective in the very young child who is diagnosed in the early stages of the disease. Surgical intervention is frequently necessary.

GENU VALGUM (KNOCK-KNEE DEFORMITY)

Knock-knee deformity occurs when the legs angle inward at the knee and then gradually outward toward the feet, so that the knees are almost touching, but the ankles are wide spread. It is commonly associated with flat feet.

Diagnosis/What to look for:
Knock-knee deformity is part of the normal development of the legs in the growing child. It typically reaches its highest magnitude at around the age of three to four and returns to normal by around age seven.  Knock knee deformity that is present or is  increasing after the age of seven or eight, is associated with pain, or is unilateral (one sided) is not normal and should be investigated by your pediatric orthopedic surgeon.

Treatment:
Most children with knock-knee deformity require no treatment. Bracing is ineffective for this problem, so in more severe cases requiring treatment, surgical intervention is necessary. When the diagnosis is made while there is still sufficient growth remaining, relatively minor procedure s can be very effective.

LEG LENGTH DIFFERENCE

Leg Length Difference (LLD) occurs when one leg is shorter or longer than the other and may occur as a result of growth stimulation or growth retardation. LLD may be caused by a number of different processes such infection, trauma or tumor, or may be the result of a congenital problem. 

Diagnosis/What to look for: 
Having unequal leg lengths does not always cause problems and may often times go unnoticed. Larger discrepancies are usually manifested by a limping gait. LLD is rarely associated with pain.

Treatment: 
LLD of up to two centimeters is well tolerated and usually requires no treatment. Discrepancy between two and six centimeters typically requires treatment ranging from a shoe lift for small LLD to growth modification or shortening of the longer side in bigger discrepancy. LLD greater than six centimeterstypically requires surgical lengthening of the short side.

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