Orthopedics - Oleksa A.P. 2006

Congenital and Acquired Deformities of the Lower Extremity
Lower Extremity Axis Deviations
Genu Valgum

As previously mentioned, valgus deformity (knock-knees; Fig. 187) can be physiological, congenital, or acquired. Until a child reaches 3 to 4 years of age, it is difficult to predict whether the alignment of the lower limbs will normalize. This can be tentatively clarified through examination: radiographically, by determining the electrical activity of the Muscles, chronaximetry, etc.

If the examination reveals no pathological Changes in the bones and neuromuscular system, there is no need for any Treatment until the age of five, as the limb alignment may still normalize on its own. Such children should lead a normal lifestyle, exercise, run, and strengthen their muscles.

It should be noted that any deviation from the normal alignment of the lower limb impairs the static-dynamic function of not only the knee but also the adjacent joints, especially the ankle. Children with valgus knee deformity may also present with flat feet and valgus deviation of the femoral neck.

To correct pes planus or pes planovalgus, children are prescribed orthopedic shoes with arch Supports, while massage and walking on tiptoes are used to strengthen the Muscles of the lower leg and FOOT. At night, corrective plaster splints are applied, or wooden splints are bandaged to the side of the limb.

In children over five years of age, there is no longer any expectation of physiological self-correction or effective conservative treatment for valgus deformity.

To prevent the progression of the deformity and secondary changes in the knee and adjacent joints, children over five years of age require surgery. The primary goal of the surgery is to restore the normal alignment of the limb. Prior to surgery, the child must be examined to determine the underlying cause of the valgus deformity.

Surgery is performed under general anesthesia. A corrective dome, step-cut, or wedge osteotomy is performed beyond the epiphyseal Cartilage to correct the valgus deformity. In the lower leg, osteotomy is performed not only on the Tibia but also on the Fibula in its upper third, with caution to avoid injury to the n.peroneus.

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Fig. 187. Valgus deformities (knock-knees) in an 11-year-old girl.

If acute correction of the normal alignment of the lower limb is achieved, it is immobilized with a long leg plaster cast. If acute correction is not possible, which is common in adolescence and adulthood, an Ilizarov apparatus is applied, and the osteotomized bones are gradually corrected over 5–7 days to normalize the limb axis. Limb immobilization is required until the bone consolidation of the osteotomized Femur or tibia is complete.

Cases of inherited genu valga hereditarium occur, as well as those resulting from uneven growth of the epiphyseal cartilage. It is advisable to operate on such children after the rapid growth spurt has ended to reduce the risk of deformity recurrence.

Since recurrence of the deformity is possible during subsequent rapid growth phases, parents should be warned of this so they do not assume the surgery was poorly performed. Such children may require repeat surgery, especially after Puberty.

Surgical restoration of the normal limb alignment combined with Muscle strengthening prevents Impairment of the static-dynamic function of the limb and The Development of osteoarthritis.