Paediatric Leg Deformities & Lower Limb Problems: When To See An Orthopaedic Surgeon in Malaysia

Introduction to Paediatric Leg Deformities

Paediatric lower limb deformities encompass a range of conditions affecting the alignment, leg length inequality and function of the legs in children. These deformities can be congenital (present at birth), or acquired due to factors like growth disturbances, trauma, infections or neuromuscular conditions.

As an orthopaedic surgeon in Kuala Lumpur, Malaysia, I encounter cases of lower limb deformity, such as leg length discrepancies and alignment problems i.e. angular deformity in children as well as adults. Proper diagnosis and treatment are crucial to ensure normal growth and function of the lower limbs.

Types of Paediatric Lower Limb Problems

Lower limb problems in children can manifest in various ways, and understanding these conditions is essential for recognising when to seek medical help.

Paediatric Leg Length Discrepancies

Paediatric lower limb discrepancy refers to a condition where there is a significant difference (2cm or more) in the lengths of a child’s legs. This condition can be congenital (present at birth) or develop over time as the child grows due to growth disturbances, infections, or previous injuries that may have affected the growth plate. Children with unequal leg length may experience difficulty walking, abnormal gait, and may develop compensatory postures that can lead to other musculoskeletal problems like scoliosis (curvature of the spine), back pain, or early degenerative joint issues as adults.

Bow Legs (Genu Varum)

Bow legs, also known as genu varum, is a condition where the legs curve outward at the knees, or an “O” shape, causing a noticeable gap between the knees when the child stands with their feet together. This condition is common in infants and toddlers and often corrects itself as the child grows. However, in some cases, especially when the bowing is severe or persists beyond the age of three, it may require medical intervention. Bow legs can result from growth plate issues, developmental problems, or conditions such as rickets, which affects bone development.

Knock Knees (Genu Valgum)

Knock knees, or genu valgum, is the opposite of bow legs, where the knees angle inward and touch each other while the ankles remain apart. This condition is also common in young children and usually self-corrects as they grow. However, if the condition is severe, it may indicate an underlying issue that requires treatment.

Deformities from Growth Issues or Past Trauma

In some cases, lower limb deformities may arise due to growth issues or past trauma that has gone undiagnosed. Injuries to the growth plate (physis), the area of developing cartilage near the ends of long bones, can disrupt normal bone growth, leading to deformities in alignment or limb length. These deformities may not become apparent until the child grows, making it essential to closely monitor their limb growth post trauma.

Role of Growth Plates in Children

Growth plates, also known as physis, are critical areas of developing cartilage tissue located near the ends of long bones in children. These plates are responsible for the lengthening and shaping of bones as children grow. However, because growth plates are softer and more vulnerable than the surrounding bone, they are susceptible to injury.

Injuries to the growth plate can have significant consequences for a child’s bone growth. If a growth plate is damaged, it can lead to uneven bone growth, resulting in deformities such as limb length discrepancies or misalignment. For example, if the growth plate in one leg is injured, the affected leg may stop growing while the other leg continues to grow, leading to a noticeable difference in leg length.

It’s crucial to diagnose and treat growth plate injuries promptly to prevent long-term complications. A paediatric orthopaedic surgeon is trained to assess these injuries and provide the appropriate treatment to support normal bone growth.

Paediatric Treatment for Leg Deformities

Non-Surgical Treatments

In many cases, mild deformities or leg length discrepancies can be managed with non-surgical treatments. These treatments may include:

Observation and Monitoring: For mild cases, especially in younger children, the condition may be monitored over time to see if it corrects itself as the child grows. Follow-up appointments are done to track the child’s development and adjust the treatment plan as needed.

Physical Therapy: Physical therapy can help strengthen the muscles around the affected limb, improve balance, and support normal movement patterns. Exercises and stretches may be prescribed to address specific issues related to the deformity.

Orthotic Devices: Custom orthotic devices, such as shoe lifts or braces, can help compensate for leg length discrepancies and improve alignment. These devices can reduce pain, improve mobility, and prevent further complications.

Surgical Treatment for Paediatric Leg Deformities

In more severe cases, surgical intervention may be necessary to correct the deformity and ensure proper limb function. The specific surgical approach depends on the nature and severity of the condition:

Growth Modulation: For children who are still growing, growth modulation techniques can be used to guide the growth of the bone and correct the deformity. This procedure involves placing small metal plates or screws on one side of the growth plate to slow down growth on that side, allowing the other side to catch up. Note that this procedure can only be done in growing children with at least two years of growth remaining before reaching skeletal maturity, which occurs around the ages of 14 years for girls and 16 years for boys.

Osteotomy: An osteotomy is a surgical procedure that involves cutting and realigning the bone and fixing it with either an internal fixation like a plate and screws or nail; or with an external fixator device like an Ilizarov frame, special frames or LRS monorail. This procedure is often used for more severe cases of angular deformities and in children who have reached skeletal maturity.

External Fixation: In cases of significant limb length discrepancies or complex deformities, external fixation devices may be used. These devices are attached to the outside of the limb and gradually adjusted to lengthen the bone or correct the alignment. External fixation allows for precise control of the correction process and can be an effective treatment for complex cases.

Healing and Monitoring Limb Deformities

Children have a remarkable ability to heal, thanks to the regenerative capacity of their bones. However, because their bones are still growing, it’s crucial to monitor their progress closely, especially after corrective surgery for a lower limb deformity or leg length discrepancy as there is always risk of recurrence particularly if the child still has many years of growth left before reaching skeletal maturity.

Regular Follow-Up

Regular follow-up appointments with a paediatric orthopaedic surgeon are essential to ensure that the treatment is working as intended and that the bones are growing and developing correctly. These appointments allow the surgeon to assess the child’s progress, make any necessary adjustments to the treatment plan, and address any new issues that may arise.

Skeletal Maturity

Children’s bones continue to grow until they reach skeletal maturity, which occurs around the ages of 14 for girls and 16 for boys. Until this point, it’s important to monitor the child’s bone development to ensure that any issues are promptly addressed. Once the child reaches skeletal maturity, the risk of further deformities due to growth plate injuries decreases significantly.

Conclusion on Paediatric Leg Deformities

Lower limb problems and leg deformities in children can have a significant impact on their mobility and overall quality of life. Early detection and appropriate treatment are crucial for ensuring the best possible outcomes.

As an orthopaedic surgeon in Kuala Lumpur, Malaysia, I am committed to providing care for patients with these conditions, helping them achieve the best possible results and supporting their healthy development.

If you have concerns about leg alignment, unequal limb length, or overall lower limb health, it’s important to seek the guidance of an orthopaedic surgeon. With timely intervention and ongoing monitoring, most children can overcome these challenges and continue to grow and thrive.

For more information or to schedule an appointment with Dr. Maria Wong, please visit drmariawong.com and take the first step towards improving your child’s musculoskeletal health.