Leg Deformities

About Limb Deformity:

• Limb deformity means, mal-alignment of extremity.
• Limb deformity can occurs in upper as well in lower limb.
• Deformity of limb can occur in direction of joint movement / opposite direction / oblique plane / rotational profile.

Causes of Limb Deformity:

• Limb deformity can present since birth (congenital) or develop later (acquired).

Congenital deformity (since birth):

• Deformity since birth can present because of some genetic issues, sporadic intrauterine event or as a part of some syndrome.
• Common congenital deformity include Proximal Femoral Focal Deficiency (PFFD), Tibial Hemimelia, Fibular Hemimelia, Radial Club Hand, CTEV (club foot), CDH, absence of part of extremity, Arthrogryposis Multiplex Congenita AMC etc.

Acquired Deformity (develop later in childhood):

• Trauma
• Infection
• Growth abnormality
• Vitamin D deficiency
• Arthritis
• Tumour
• Growth plate injury
• Perthes

Signs and Symptoms of Limb Deformity:

Sign and symptoms are depends upon site, cause & severity of deformity.

It is the appearance of extremity is very obvious finding in most of children with limb deformity It may not visible on curious observation if it is mild abnormality

In sever limb deformity, child may not be able to take full load on limb.

Symptom:

• Difficulty in walking
• Awkward gait pattern,
• Pain in joint & limb
• Inability to perform activities
• Limb shortening
• Inability to take weight on limb during walking.
• If joint deformity present for long duration then child develop arthritis and have pain in joint.

Different Types of Limb Deformities:

Types of limb deformity is depend upon site of deformity.

Foot:

• Club foot (CTEV)
• Cavus deformity
• Plano valgus deformity
• Equines deformity
• Calcaneus deformity

• Flat Feet

Leg & Knee:

• Bowing, Genu Varus
• External / Internal Tibial torsion (in-toeing/out-toeing)
• Genu valgus,
• Hyperextension (Genu Recurvatum),
• Flexion deformity (Bending at knee)

Thigh & Hip:

• Femoral bowing
• Femoral torsion
• Flexion deformity
• Hip dysplasia

Upper limb:  

• Volkman Ischemic Contracture (VIC)
• Radial club hand
• Wrist Flexion/ Extension deformity
• Forearm rotation deformity
• Elbow flexion/ extension deformity.

Most of the limb deformity can be associated with problem in joint, muscle & shortening etc.

How Limb Deformity Can be Prevented:

• Congenital limb deformity cannot be prevented but acquired one can be prevented up to certain extent.
• In congenital variety early detection just after birth, early planning of treatment can prevent lots of future complication.
• In post-traumatic cases, timely intervention can prevent future development of deformity except in some physial injury etc.
• In Rickets, vitamin D supplement can prevent the future progression of disease.
• In infection early treatment can prevent further damage of bone and joint.

Treatment for Limb Deformity:

• Treatment of limb deformity is based on many factors including age, aetiology, site & severity of deformity.
• Defining the cause of deformity is very crucial for treatment planning.
• We need to decide goal in treatment of deformity
• Goal in treatment planning is alignment of extremity, appearance & functional improvement.

Non- surgical treatment:

• In developing / early deformity, we need to protect limb by the use of exercise & brace.
• After surgery, we need to prevent recurrence of deformity by the use of plaster/ brace
• In Rickets, only vitamin D supplement can correct the deformity.
• Progression of deformity in few variety correct itself by natural growth of child.
• When we are not able to treat deformity due to financial, social or medical ground then child need to use extension prosthesis/orthosis/ special shoes.

Surgical treatment-

• The type of surgery can only be decide after detail assessment of child.
• We need to take many think in consideration before embarking on surgery.
• Muscle contracture can be managed by tendon / myofascial lengthening.
• Bone & joint deformity need bony osteotomy
• Muscle is weak then transfer of spared normal tendon in place of weak tendon is being done.
• Deformity near joint in child can be managed by growth modulation in which physial plate growth can be modulated by the application of eight plate / screw.
• In adult correction can be done by bone osteotomy (cutting of bone & correcting the deformity) and fixation with plate/ nail or fixator.
• Gradual correction of deformity can also be done by the use of ring fixator (Ilizarov fixator).
• Ilizarov also helps in regaining length along with deformity correction.

Reference Links :

• https://www.cdc.gov/ncbddd/birthdefects/ul-limbreductiondefects.html
• https://www.msdmanuals.com/en-in/professional/pediatrics/congenital-craniofacial-and-musculoskeletal-abnormalities/congenital-limb-abnormalities

Frequently Asked Questions