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Management of bow legs in children: A primary care protocol
Samuel Dettling1,2, Dennis S Weiner3
1Akron Children`s Hospital, Ohio, USA.
Insights
This study developed a primary care protocol to manage physiologic bow legs, using simple assessments to track varus progression and identify cases needing orthopedic referral. Most bow legs cases can be managed non-surgically with regular follow-up.
Area of Science:
- Orthopedics
- Pediatrics
- Primary Care Medicine
Background:
- Physiologic bow legs (genu varum) are common in infants and typically resolve spontaneously.
- Distinguishing physiologic genu varum from pathologic bowing, such as infantile Blount's disease, is crucial for appropriate management.
- Unnecessary orthopedic referrals can increase healthcare costs and patient burden.
Purpose of the Study:
- To develop and evaluate a primary care protocol for managing physiologic genu varum.
- To reduce unnecessary orthopedic referrals by providing a framework for noninvasive monitoring.
- To identify children with potential pathologic bowing requiring specialist orthopedic evaluation.
Main Methods:
- Retrospective study of 155 patients with physiologic genu varum and 10 with infantile Blount's disease.
- Utilized fingerbreadth measurements to track the progression or resolution of bow legs.
- Categorized patients by age at presentation (before 18 months, 18-23 months, 24+ months) for protocol development.
Main Results:
- Physiologic genu varum patients walked earlier than average infants (10 months vs. 12-15 months).
- Correction of physiologic genu varum was observed between 18-30 months, with resolution by 30-36 months, depending on presentation age.
- Infantile Blount's disease served as a comparison for pathologic bowing.
Conclusions:
- Primary care physicians can effectively manage most cases of physiologic genu varum.
- A follow-up protocol using well-child checkups and clinical assessment can monitor varus progression.
- This approach aids in screening for pathologic bowing, guiding orthopedic referrals appropriately.
Objective:
To reduce unnecessary orthopedic referrals by developing a protocol for managing physiologic bow legs in the primary care environment through the use of a noninvasive technique that simultaneously tracks normal varus progression and screens for potential pathologic bowing requiring an orthopedic referral.
Methods:
Retrospective study of 155 patients with physiologic genu varum and 10 with infantile Blount`s disease. We used fingerbreadth measurements to document progression or resolution of bow legs. Final diagnoses were made by one orthopedic surgeon using clinical and radiographic evidence. We divided genu varum patients into 3 groups: patients presenting with bow legs before 18 months of age (MOA), patients presenting between 18 and 23 MOA, and patients presenting at 24 MOA or older for analyses relevant to the development of the follow-up protocol.
Results:
Physiologic genu varum patients walked earlier than average infants (10 months vs 12-15 months; P<.001). Physiologic genu varum patients presenting before 18 MOA demonstrated initial signs of correction between 18 and 24 MOA and resolution by 30 MOA. Physiologic genu varum patients presenting between 18 and 23 MOA demonstrated initial signs of correction between 24 MOA and 30 MOA and resolution by 36 MOA.
Conclusion:
Primary care physicians can manage most children presenting with bow legs. Management focuses on following the progression or resolution of varus with regular follow-up. For patients presenting with bow legs, we recommend a follow-up protocol using mainly well-child checkups and a simple clinical assessment to monitor varus progression and screen for pathologic bowing.
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