Angular malalignments of long bones are commonly seen in an OPD setting. In most cases, symmetrical deformities and the absence of symptoms present a benign condition with excellent long-term outcomes.

On the contrary, deformities that are asymmetrical and associated with symptoms may indicate a serious underlying cause leading to aesthetic and functional deficits that will require surgical orthopedic treatment.

At what age can angular deformity of bones be considered a pathology?

The newborns have a physiological genu varum which is highest around the age of 1 year and later as the child grows the lower limbs become straight and then further progress to Valgus between the age of 3-4 years. It reaches normal angulation of 7-10 degrees by the age of 7 years. If they persist after the age of 9, they may require surgical treatment.

Angular deformity causes

It’s known that the most frequent causes of angular deformity of long bones in children are growth disorder, previous trauma or injuries, or a pathologic condition – often caused by Blount’s Disease (tibia vara), or vitamin D deficiency.

Angular deformity diagnosis

Familiarity with the natural history of angular deformities and with normal growth patterns is necessary to diagnose and evaluate malalignment. Diagnosis is usually done by clinical examination and X-rays.

Angular deformity treatment options

Treatment options depend mainly on the degree of bone deformity and the age of the child.

Treatment is rarely required if the child is under 18 months.

Skeletally immature children with at least 2 years of growth left can be treated with Growth Modulation (Hemiepiphysiodesis) [as shown in images above], while the skeletally mature children with closed/fused growth plates require Osteotomy (cutting the bone) & Fixation.

Growth Modulation [as shown in the images above] is a lesser invasive procedure that involves the application of small plates and screws in distal femoral physis or proximal tibial physis to control the growth at the Growth plate and thereby correct the deformity gradually without cutting the bone.

The growth modulation corrects deformities at an average rate of 0.7 to 1.2 degrees per month. The advantage of this procedure is early recovery, no immobilization in plaster, and the child can regain regular activities within a day.

What can happen if a bone deformity is not corrected in time?

If left untreated, or not treated in time, the bone deformity can deteriorate with age and lead to major complications. While growing, your child will gain weight, which adds extra stress to his/her joints. The bone deformity can become permanent and in time your child can develop osteoporosis, with a further reduction of mobility and more fragile bones. There can also be increased severe functional and aesthetic problems, nerve damage, and pain.