Lower limb >

　　Lack of calcium and heredity are the two basic factors in the formation of bow legs, but the more direct cause still lies in posture during walking, standing, sitting, and some sports.

　　Walking with feet turned out, standing at ease with the feet apart, wearing high heels for a long time, sitting cross-legged, kneeling, squatting in the horse-riding posture, and so on, will exert an outward force on the knee joint, and this force will pull the lateral collateral ligament of the knee joint, leading to its relaxation over a long period of time.

　　The medial and lateral collateral ligaments of the knee are the stable structures of the medial and lateral angles of the knee joint. When the lateral collateral ligament is relaxed, the excessive force of the medial collateral ligament will pull the tibia of the lower leg medially, forming bow legs.

　　It can be seen that the idea that bow legs are all due to bent bones is a misconception.

　　There are many causes of baby bow legs, such as chondrodysplasia, but vitamin D deficiency rickets is more common. In the early stage, the main symptoms are polydipsia and easy to be startled. If not corrected in time, it will affect the development of bones. When the rickets child grows to about 1 year old, when learning to stand and walk, the lower limbs are difficult to bear the weight of the body, which will lead to the lower limbs bending outward to form bow legs.

　　This condition is osteochondritis or epiphysitis, the etiology is unknown, and it may be related to trauma or allergy, including tuberculosis and syphilis. There is a growth defect in the epiphyseal cartilage, and the ossification of the medial or lateral part of the tibial epiphysis is delayed. Due to lower limb deformity, there is a dysfunction of lower limb movement, and the body is short.

　　The symptoms of bow legs are as follows:

　　1. Internal or external genu deformity, early on, there is often no discomfort, or only walking discomfort, weak legs or easy fatigue, unable to walk or stand for a long time.

　　2. Abnormal gait, walking in an 'eight' or 'duck' shape, with varying degrees of walking difficulties.

　　3. When the lower limbs are extended, the distance between the knees or the medial malleoli increases.

　　The development of motor function in infants and young children is a slow and gradual process in the physiological development of children. Because in the early stage of the baby's skeletal tissue, there is more gelatin and less calcium, making the bone tissue relatively soft and susceptible to deformation under external forces. In their muscle tissue, especially the lower limbs are more delicate, with fine muscle fibers and high water content. If walking practice is too early, the full weight of the body must be supported by the lower limbs, which often leads to bending and deformation of the two legs, resulting in bow legs, affecting the baby's future body shape and the normal exertion of motor ability.

　　6. The general regularity of physical development in children suggests that it is best to determine the period of learning to walk for the baby after 11 months.

　　7. If possible, allow the baby to walk barefoot on wooden floors in moderation.

　　8. It is not recommended to learn to walk using a walker, as this does not allow the baby's legs to be fully exercised.

　　Genu varum and genu valgum are relatively common lower limb deformities, mainly caused by knee deformities due to rickets or osteomalacia. The following examinations need to be performed.

　　1. Infantile type

　　The main findings on X-ray photographs are the inward angulation of the upper end of the tibia and the inward deformity of the distal part of the femur. There are a series of changes in the metaphyseal end of the upper part of the tibia and the epiphysis, which depend on the degree of bone development and maturity. The severity and course of the disease vary greatly, with some children showing complete disappearance of X-ray findings by the age of 3 to 4 years. However, in other children, changes may still exist by the age of 10 to 13 years.

　　2. Adolescent type

　　The X-ray findings of this type are quite different from those of the infantile type. At this stage, the secondary ossification centers have already formed, and the lesion is relatively localized. The middle part of the inner 1/2 of the epiphysis plate becomes narrow, the bone density on the opposite side increases, the shape of the epiphysis is normal, and the epiphysis plate does not show a stepped appearance. The distal part of the femur also shows an inward deformity, while the distal part of the tibia shows an outward deformity. Unlike the infantile type that naturally develops into adolescence, the medial epiphysis plate of the tibia in the adolescent type shows early closure, while the latter has a bone bridge formation.

　　Bow legs lead to lower limb deformity, resulting in lower limb motor dysfunction and short stature.

　　1. Eat foods rich in calcium such as fish, shrimp shells, shrimp, seaweed, and dairy and bean products.

　　2. Maintain a light and nutritious diet, eat more vegetables and fruits such as bananas, strawberries, and apples. These are rich in nutrients and eating them can increase immunity, such as propolis. This can enhance personal disease resistance. In addition, it is necessary to reasonably match the diet and ensure adequate nutrition.

　　3. Avoid smoking, drinking, spicy foods, greasy foods, and smoking. Avoid eating cold foods to prevent recurrent attacks of the disease.

　　The correction methods for bow legs include: surgery, orthotic instruments, splints, bandages, exercises, corrective insoles, etc.

　　Surgery is suitable for patients with very severe bow legs or those who have developed osteoarthritis, resulting in joint pain. The benefits of surgery are passive treatment and immediate correction, but the disadvantages are the need for bone resection, significant side effects, and high pain and risk.

　　The basic principle of non-surgical correction methods is essentially the same, which is to relax the medial collateral ligament of the knee joint to restore the stable structure of the knee joint's internal and external sides. This allows the tibia to externally rotate and achieve the correction goal.

　　The advantages of non-surgical correction methods are low cost and low risk, but the disadvantages are active treatment, slow effect, and the need for long-term persistence. Without perseverance, the correction goal cannot be achieved.

　　Among the current non-surgical correction methods, the best and fastest-acting is the orthotic instrument.

　　If the examination of the lower limb bones by X-ray shows that the bow legs are caused by skeletal anatomical axis deformity and lead to discomfort in the knee joint, then it has surgical indications.

　　The so-called relaxation of ligaments is an 'aimless' method.

　　Otherwise, orthopedics will not be taught as a curriculum in medical universities across China.