O-shaped legs - Causes, Symptoms, Diagnosis and Treatment
O-shaped legs (Varus deformity of the lower limbs) - a pathological condition in which the legs are bent at an angle, open inwards. Typically, this pathology occurs due to the arcuate or, more rarely, angulate curving legs, arising as a result of congenital malformations or diseases associated with a decrease in bone strength. It is accompanied by compensatory deformation of other parts of the lower extremities, especially the feet. Diagnosis is exposed on the basis of the inspection data X-ray, CT, MRI and other studies. Treatment can be either conservative or surgical.
O-shaped legs
limb deformity, in which a person standing with a note with your feet, knees do not touch, and are at some distance from each other. At the same time the gap between the legs formed, resembling the letter "O". It is quite widespread pathology. Normally seen in children under the age of 24 months. When you save the O-shaped installation in older age requires conservative or surgical correction.
Although varus bending leg is considered relatively favorable flowing deformation compared with valgus curvature, this pathology also entails negative consequences. When bending shins varus foot compensatory "leave" in the perverse situation that leads to the secondary flat feet. Due to the deformation of the main and secondary changes in the functional capacity of extremities deteriorates. There is an overload of the joints, develops posture disorder, increases the likelihood of early arthritis and osteoarthritis. All this testifies to the high relevance of the problem of the O-shaped legs in modern traumatology, orthopedics and pediatrics.
Anatomy
Normally, all newborns there is a slight curvature of the arc-shaped shanks (20 degrees) due to intrauterine fetal position. At the same time the child's lower leg are symmetric, and the shape and position of the stop may be asymmetric. For the 2nd year of O-shaped deformation disappears and is gradually replaced by an X-shaped (valgus). A slight valgus bending shins (15 degrees) is stored up to 3 years, and then begins to decrease and to 8 years does not exceed 7-9 degrees. Subsequently, perhaps as a complete disappearance of the curvature, and the preservation of small residual angle.
Varus bending, continuing at the age of 2 years and older, is the cause of the abnormal development of the knee. The outer femoral condyle increases, decreases internal. The joint gap becomes uneven - narrowed inside and outside expanded. The inner meniscus is squeezed by the outer surface of the joint ligaments are stretched. First, take the foot position ploskovarusnuyu their anterior and heel deflected inwards. Subsequently formed compensatory ploskovalgusnaya feet deformity. In severe cases, the tibia medially rotated, and hip - outwards. Limited flexion in the knee joints. There are disturbances of gait and fatigue when walking. Because of the displacement of the center of gravity, load redistribution and other pathological changes in children with O-shaped legs changing posture, sometimes develop curvature of the spine (kyphosis or scoliosis).
fibrocystic dysplasia of the tibia. In contrast to the physiological varus curvature of the observed deformation unevenness in this pathology (one shank is curved larger than the other). The outcome of congenital hypoplasia of the shin bone can become pseudarthrosis.
Traditionally, one of the first places in the list of causes of O-shaped legs takes rickets. Although today in Pediatrics this pathology is rare, it can occur, so it should always be ruled out in the differential diagnosis. It should be borne in mind that rickets can develop in three periods of life: in utero (ie, be congenital), at an early age and in adolescents. The cause of fetal fetal rickets is a vitamin D deficiency in the mother. Currently, such a pathology is detected, mainly in economically disadvantaged countries.
Infantile rickets occurs after weaning. At this stage of development of the child's body requires a large amount of vitamin D. If your baby is not getting the vitamin in sufficient quantities, his bones are not strong enough, and gradually bend when walking. Did O-shaped curvature as the lower legs and thighs. In some cases the asymmetric deformation: varus curvature on the one hand combined with valgus curvature on the other hand. It may also be formed in front bend - the so-called saber shin. At the same time, in contrast to the lesions of syphilis shins, when the lower leg bent just in front, there is a combination of strain in the lateral and anteroposterior direction.
Another critical age, which increases the likelihood of developing rickets, a period of intense growth in adolescents. The reason for the formation of the deformation becomes lack of sun exposure, vitamin D deficiency in the diet, poor living conditions and some disease. There are persistent late rickets, which, in contrast to the usual form of the disease does not respond to treatment with standard doses of vitamin D. Resistant rickets develops due to genetic predisposition, chronic kidney disease and steatorrhea.
Intestinal rickets (rickets when steatorrhoea) can occur with any type of current long-term bowel disorders. Absorption occurs due to the deterioration of fats, vitamins, calcium and phosphate. Such violations can be detected in adults, but in the latter case, there is no rickets and osteomalacia. The reason for the development of renal rickets become chronic kidney disease, preventing the retention of phosphate and calcium in serum. When renal rickets is more common valgus deformity, but it is possible, and the O-shaped curvature.
Another reason for the formation of the O-shaped legs is Blount's disease (osteochondrosis deformans tibia). In this disease there is not arched, as in rickets, and angulate tibia bending deformation with vertex at the level of the proximal epiphysis. At an early age (2-4 years) at Blount's disease is usually detected bilateral bending, at an older age can be bent only one drumstick.
In adults, the O-shaped legs can be formed with Paget's disease (deforming ostite), accompanied by a lesion of the femoral and tibial bones. Perhaps more like a defeat, and one bone, but most often it involves several bones in the process. The curvature is caused by overgrowth of bone tissue with its lack of destruction. In this newly formed bone does not have sufficient strength due to incomplete calcification. It thickens and becomes soft at the same time, causing bending and shear fractures.
orthopedic and children's traumatologist. The most important task when examining patients with O-shaped legs is to identify the underlying disease that caused the deformation. When the diagnosis takes into account the clinical picture, especially the curvature, the age at which the first symptoms, family history and the state of other organs and systems. All patients with O-shaped legs appoint radiography shin. When concomitant deformation of the upper parts of the limbs additionally perform radiography thighs, if you suspect the presence of compensatory changes in other parts of the limbs - X-rays of the hip joints and feet radiographs.
To study the level of rickets exception of alkaline phosphatase, phosphorus and calcium in blood tests. If you suspect a stable form of rickets caused by kidney disease and gastrointestinal tract, the patient is sent for consultation to a nephrologist and a gastroenterologist. To eliminate the disease and Paget's disease Blount radiographs examined, if necessary, appoint more MRI and CT shins. To identify genetic predisposition pore over family history.
Exercise therapy, massage, and customized orthoses specially made orthotics. According to the testimony is the treatment of the underlying disease. Note that the correction of O-shaped deformation without addressing its causes can be ineffective and in some cases even lead to the progression of the curvature, the formation of false joints, and so on. D.
Adults may only hot fix leg shape. Typically, the O-shaped legs perform corrective osteotomy combined with the imposition of Ilizarov frame. Incomplete osteotomy (cutting the bone on the inner surface only) used for true O-shaped curvature and favorable from an aesthetic point of view of the distribution of the soft tissues of the lower leg. Otherwise, use the full osteotomy. Depending on the size and nature of deformation is possible both cross-sectional and the gradual elimination of the curvature. In the first case, the patient's tibia is output immediately to the correct position, in the second mutual position is corrected fragments gradually "unwinding" nuts and increasing the distance between the inner side of the rings. In the postoperative period prescribed exercise therapy and physiotherapy. It usually takes about 2 months to correct the shape of feet, but when expressed strains, this period may be extended.