“A child’s leg bent in an O∙X shape, at this time, treatment should be started” [인터뷰]

What if your child falls more often than his peers and the way he walks seems clumsy? Be sure to watch your child’s legs to make sure they are not bent. In particular, in case of severe bent leg form after 6 years of age, a diagnosis by a specialist is necessary.

Hidak Orthopedic Consultant Director Park Sang-eon (Yonsei Barun Hospital)“Even when the physiological transformation is finished around the age of 6, if the deformity seems to be severe, you need to see a specialist.” Regarding the reason, he said, “If you try to treat a bent leg after the growth plate is closed, surgical treatment is often required. Because,” he explained. Next, he explained in detail how to treat bent legs in children and how to manage them that parents should know. The following is a Q&A on ‘Children bent legs’ delivered by Director Park Sang-eon.

Q. What is the cause of a child’s leg bent in O·X?
First, parents need to know about how their child’s legs grow. In general, most children from birth to an average of 18 months have an O-shaped leg. After that, at about 16 to 24 months, the legs straighten, and as two stones (24 months) pass, the legs bend into an X shape, and at the age of 4 to 6 years they change back to a straight leg shape. Knowing how these legs develop can help parents keep an eye on the shape of their child’s legs.

Leg Growth Process|Source: Hidak

In other words, most bent legs before the age of 4-6 are caused by physiological deformation, which is a normal growth process. Lifestyle habits can be one cause of a slight bend in the leg. Typical lifestyle habits that affect the deformity of the legs in children include incorrect gait and sitting posture with legs folded on the floor. In addition, diseases that require detailed examination or treatment, such as infancy tibial varus disease, metaphyseal dysplasia, Blount’s disease, and rickets due to vitamin D deficiency, can cause bent legs in children.

Q. I wonder if professional treatment and treatment are required.
If you consider the above points in reverse, △O-shaped legs after 3 years old △X-shaped legs before 2 years old △Bending legs that get worse over time △Asymmetrical bent legs △Treatment if you are exceptionally short is most likely needed.

A typical example is tibial varus in infancy, which is a disease in which the calf bone does not straighten like the physiological O-type deformity, and the O-type deformity becomes more severe. It tends to occur more often in obese children, and it has been reported that the incidence is increasing recently. It is very difficult for parents to tell whether this is a natural physiological transformation of the growing season or not. If you are obese and asymmetrically deformed on one side, you should be suspicious.

Q. If so, when is the right time for treatment?

If the deformity seems severe even at the age of 6, when the shape of the legs is straightened, that is, when the physiological transformation is finished, you need to see a specialist. After the growth plate is closed, trying to treat the bent leg often requires surgical treatment, so it is better to solve the problem before that.

Q. Could you please explain what kind of treatment is being carried out and whether a cure is possible?
Relatively good results can be obtained if correction can be done with braces, elizarov, staples, etc., before growth is complete. However, if this period passes and the bent leg continues even when the growth plate is closed, it is practically difficult to correct it with exercise, orthodontic treatment, or non-surgical treatment such as orthodontic devices.

If the diagnosis is made around the age of 6 or 7 and treatment begins, the treatment can be performed by wearing a foot orthosis for 3 to 4 hours. It is similar to orthodontic treatment in childhood.

On the other hand, it is difficult to improve the severe X-shaped legs of children aged 8 to 9 years with orthosis. If you really want correction, you will need surgery, so if it’s not severe, you can watch it. Even though it looks serious to the naked eye, there are cases when it is not severe on an X-ray examination, and the opposite is often the case. Children often gain muscle as they grow, and their appearance improves as they gain weight.

In fact, if the bent leg is severe on the X-ray examination, corrective surgery may be considered. With surgery, it can be treated with a completely straight leg. In addition to the aesthetic effect, you can see the effect of slightly increasing the height depending on the degree of correction.

In conclusion, if your O-shaped or X-shaped legs look very severe, or if you are worried that you will have a complex with the shape of your legs when you grow up, it is better to see a specialist first rather than worrying about it at home.

Q. A bent leg that needs treatment, does it cause other problems besides the appearance if left unattended?

It’s not a big deal when you’re a kid, but it can be a problem as you get older. Severe bent legs may not have any special functional problems, but over time, when degenerative changes begin to occur in middle-aged and older adults, the speed of degenerative arthritis can be accelerated. Even minor injuries can easily cause inflammation, which can also cause muscle imbalances. In addition, when treatment such as surgery is required for degenerative arthritis in the future, the treatment of degenerative arthritis is more complicated than that of a straight leg and there is a high possibility that rehabilitation will be more difficult.

To improve bent legs, parents must actively intervene in their children's lifestyle | Source: Getty Images Bank

Q. There are parents who use methods such as braces or massage to correct their children’s bent legs. Are these home remedies effective?
In order to improve the bent leg, parents must first actively intervene in the child’s lifestyle. It is recommended to teach the child of the long legs the correct posture and habits, and to encourage them to lead a life of standing rather than sitting. In the future, it is also necessary to educate about changes in the shape of the legs, uncomfortable living, cosmetic problems, and degenerative changes. On the other hand, you need to be careful when using orthoses or massaging your child.

In general, when you visit a hospital to treat a bent leg, a brace that you can wear at home is often recommended, but it is difficult to see a dramatic correction effect with the brace. You can think of it as Blount’s disease (abnormality of the proximal medial growth plate of the tibia) that has medically proven the effect of an orthosis on a bent leg. It may look better temporarily with orthosis, but it does not change the degree of curvature of the bone due to the period of growth to a certain extent.

In addition, if the orthosis is worn in an inappropriate situation, the bending force of the orthosis tends to act as a force that twists the joint between the bones rather than acting on the bone. In this case, you can rather put a load on the joints. Also, seeing a brace being worn may create a negative and distorted view of your child’s body, and may cause discomfort or potential stress while sleeping. Therefore, it is not recommended to use braces for children who will naturally improve as they grow up without wearing braces. Wearing an inappropriate orthosis goes beyond cost and can even harm a child.

In addition, the jjangjjikgyun gymnastics, which is often done in infancy, is not effective in correcting the shape of the legs. Stretching doesn’t stretch your legs more or faster. This is especially bad for newborns with flexible hip joints. This is because there is a risk of hip subluxation. Therefore, it is better not to apply too much force to affect the joints, but light enough to loosen the muscles. Stretching at moderate intensity may help a bit to relax your muscles.

Help = Hidak Consulting Doctor Sang-eon Park (Yonsei Barun Hospital Orthopedic Surgeon Specialist)

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