Genu varus and valgus in children.

Abstract

Böhm (1, 2) was the first to suggest that varus (bowlegs) and valgus (knock-knees) might be normal growth patterns in infants and children. Most experienced pediatric radiologists have observed spontaneous correction of bowlegs and replacement with knock-knees (Fig. 1). Several workers have published case reports to caution that bowlegs and knock-knees may not be primarily abnormal and advise therapeutic conservatism (3–6, 8). Although Böhm and Price (6) are credited with the recognition and earliest descriptions of varoid and valgoid growth patterns in normal children, they considered it pathological if beyond a certain degree of severity, without clearly distinguishing between the normal and abnormal. Still persisting and intact today is the concept of pathological varus and valgus in otherwise healthy children. A closely watched and appraised indicator of child development is the gait and walk of a child; when he walks and how he walks. The hazard is that specific attention directed to varus and valgus, which may be normal, will be a cause for undue concern to parents and physicians and result in unnecessary treatment because of misinterpretation of normal as abnormal. The purpose of this paper is to report the results of a study of the lower extremities of healthy children to clearly establish the normal and to evaluate the presumed abnormal with the normal. Material and Methods The lower extremities were examined in two groups of children which are designated as normal and pathological. Five hundred sixty-eight children are in the normal group because they are from an orphanage, the well-baby clinic, and the referred pediatric radiology practice and had no specific complaints referable to the lower extremities. They were all healthy except those referred because of upper respiratory infection and trauma. At a minimum interval of one year 322 had at least one follow-up examination. The breakdown by age group is shown in Table I. There are 61 patients considered pathological because they were referred specifically for either varus (bowlegs) or valgus (knock-knees). They were all healthy children otherwise, and therefore the bowlegs and knock-knees were only presumed to be pathological. Those who received no treatment served as controls, in addition to the normal, for those who did receive treatment (Table II). All patients received a physical examination in which the subject stands comfortably, allowing either the ankles or the knees to touch, and the distance between the knees (varus) and the ankles (valgus) respectively is measured (Fig. 1, C and D). Roentgenograms of the lower extremities, centered at the knees, were taken exactly as they were positioned for the physical examination. The measurements from the physical examination and the roentgenograms of the normal group were evaluated to determine growth patterns for the various ages and establish guidelines for degree of normal varus and valgus without creating absolute limitations.