Bow Legs

Bow legs or Genu varum is a pediatric medical condition if the developing child's legs do not straighten up during the stages of walking. At birth children usually have bow legged appearance which gradually disappears. It is necessary to differentiate between rickets, Blount's disease and bow legs as the former is caused because of vitamin D deficiency. In a developing child, the bow legged condition slowly disappears. Orthopedic opinion is necessary if the child complains of pain or limping as it may indicate some other associated condition. Bow legs usually last for first two or three years and gradually a right posture is noticed.

Iliotibial Band Syndrome

Iliotibial Band Syndrome or 'Ilitibial Band Friction Syndrome' is a common sports injury generally associated with running. This syndrome is bound to cause lateral knee pain in runners. This injury can also be caused by biking, hiking and weight lifting. This Iliotibial band is a thick fibrous tissue that runs from the outside of the pelvis, over the hip, knee and below the knee joint. The band stabilizes the knee during movements like running. The band coordinates with several other thigh muscles and moves from behind the femur in the thigh to the front during the gait cycle. The Iliotibial Band Syndrome refers to the superficial thickening of the tissue that is on the outside of the thigh. Continuous rubbing and flexing of the band causes irritation usually over the outside of the knee joint.

Common causes of the Iliotibial Band Syndrome among runners

• Iliotibial Band Syndrome occurs when the level of activity increases especially among runners who tend to increase their mileage. Increasing distance too quickly or excessive downhill running is a common cause among runners.
  
• Poor training habits in runners can cause this syndrome. While running on an indoor track, the leg bends slightly inwards and this causes extreme stretching of the Iliotibial band and the resultant injury.
  
• Inadequate warm up and cool down sessions among sports persons can cause this syndrome.
  
• While cycling, having the feet 'toed in' at an extreme and excessive angle can cause the Iliotibial band injury.

Individuals with anatomical abnormalities of the leg such as bow legs, high or low arches, overpronation of the foot and uneven leg length are prone to this condition. Muscle imbalance such as weak hip abductor muscles can lead to iliotibial band syndrome.

Symptoms of this syndrome include pain in the knee joint that worsens with continued movement and resolves on rest. There is persistent pain below the knees or stinging sensation just above the knee joint. Often swelling or thickening is noticed at the point of knee joint where the band moves over the femur. Persons suffering these symptoms must avoid running downhill or squatting, playing tennis or basketball and indulging in martial arts.

Treatment for Iliotibial Band Syndrome normally begins with applying ice the area of injury, selection of proper footwear and stretching routine. While icing, the injured part has to be kept elevated as this helps to reduce swelling. Anti-inflammatory medications and cortisone injections may be prescribed to reduce the inflammation. Surgery is rarely resorted to.

Osteotomy

Osteotomy is a procedure wherein a bone or a portion of the bone is cut. Osteotomy refers to a variety of bone cutting procedures that are used to correct deformity, relieve pain from arthritis and for cosmetic changes. It is an elective surgical procedure and is performed under general anesthesia. The damaged bone near the affected joint is removed surgically.

The bone is fixed by either cutting it short or lengthening it or correcting the damage. The damage may be caused by trauma, arthritis or growth abnormalities. Cutting through the bone allows repositioning of the bone thereby remodeling the appearance, position and transferring the point of stress. Osteotomy procedure helps in shifting the weight from the area of the damaged cartilage to the area where there is normal or healthy cartilage.

This surgical procedure is carried out mainly for the knee and the hip joints. Though any bone can be repaired or repositioned using this procedure, the list includes hands, vertebrae, arms, middle ear, hips, jaws, ankles, toes and shoulder blades.

Osteotomy corrects various deformities such as bow legs, knock knees and deformity of the big toe. This procedure is usually performed on those who have a broken bone that has healed crookedly Or when the bone plate experiences a trauma and heals unevenly. This procedure is effective only when one side of the joint is affected. People suffering from osteoarthritis often prefer an osteotomy over a total replacement of the joint.

• If osteotomy is performed on the inner knee, the surgeon removes the bone from the outer side of the tibia/large lower leg bone near the knee.
  
• Osteotomy of the hip includes removing bone from the femur/upper thigh bone.
  
• This procedure tilts the body weight of the person towards the healthier cartilage that is located on the outer knee.
  
• The weight is spread evenly across the joint cartilage.
  
• Once the bone wedge is removed, the remaining bones are secured with pins or staples.
  
• If the procedure is for the outer knee, the bone from the inner side of the lower leg is removed so as to shift the weight towards the inner knee.

Osteotomy helps in postponing joint replacement for a few years; this procedure is usually carried out on young people. Post surgery, for about 4-8 weeks a splint or cast is used to limit the movement. Once the cast is removed, physical therapy is advised for a few weeks. Post surgery - it may take up to 12 weeks for the person to apply complete weight on the joint and may take up to a year for the joint to adjust to the corrected position.