X-legs and bow legs in children

X and O legs in children

Correction of the X-legs or bow legs in infants is usually not necessary and cannot be influenced even with extensive physiotherapy. X-legs, which appear in prepubescent growth and show a shift of the leg support axis, can be corrected quickly and easily with a small surgical intervention.

Deviations in the leg axes are a common finding in children. There are two frequency peaks, namely after the start of the run up to the 3rd – 5th year of life. On the other hand, leg axis deviations increasingly occur in the pubertal growth spurt (from the age of 9). X-legs are much more common than O-leg formations.

The development of an X-B position after the start of a run is usually a normal finding and is related to the effects of gravity on the body and the muscular control mechanisms of the lower extremity. This is almost always accompanied by a kink-flat liquid that does not require treatment. Therapy of this X-leg in infancy is not necessary, since spontaneous correction is usually carried out up to the age of 6. With X-legs, which show a rapid increase and remain beyond this age, there is always the question of additional diseases of the musculoskeletal system and the internal organs (kidney), which require clarification as part of a pediatric orthopedic consultation.

before surgery with marked X-leg angle

Blockage of growth plates (temporary epiphysis). Screw right and left – leveling of the previous X-legs

For X-legs that appear in the prepubertal growth spurt and show a steady increase, a medical check-up is recommended at certain intervals. If the leg axis then deviates increasingly from the standard value (this is the case with an inner ankle distance of approx. 10-12 cm), the carrying axis is shifted into the outer knee joint compartment and thus an increasing non-physiological load on these joint structures. External meniscus damage and early cartilage wear can result. In the growth spurt there is therefore a very good opportunity to normalize the axis near the knee joint with a comparably small surgical intervention. This procedure is carried out minimally invasively in order to achieve a temporary growth joint closure of the inner thigh joint (that is to say reversible). If, on the other hand, you wait until the growth is complete, an axis correction can only be carried out with extensive surgical interventions.

Occurrence of a bow leg after the start of the run is occasionally found in children who straighten up very early. It is also called persistent bow leg due to the retention of the O axis from the infant phase. This axis deviation is often associated with more or less severe internal turning errors in the lower leg. Here, too, spontaneous "healing" is usually to be expected up to the age of 3, and physiotherapy or dressing is not necessary.

In the case of bow legs that do not correct themselves spontaneously or show a continuous increase, further diagnostics are absolutely necessary in order to rule out skeletal diseases (primary causes) or metabolic problems (secondary causes). These O-leg formations then require special conservative or surgical therapy and, in contrast to the O-leg mentioned at the beginning, can be described as pathological.

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Christina Cherry
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