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Common orthopaedic conditions in children are part of growth.

Summary: Conditions such as bow legs, knock knees and in-toeing are usually outgrown but parents must monitor the child's progress

Mary Achkhanian, Staff Reporter

Dubai: Common orthopaedic conditions in children should not be a concern to parents unless they begin to deteriorate or affect the child's comfort and activity level after a certain age, orthopaedic specialists in the UAE said.

Conditions such as in-toes, flat feet, bow legs and knock knees can manifest in many infants and small children and these orthopaedic conditions can affect the shape of their legs and feet. Many parents are understandably anxious about these conditions as they are perceived as deformities.

Medical experts, however, reassure worried parents that these physiological appearances in children are quite common and are non-threatening conditions that will be outgrown.

"In most cases, these conditions are not serious health concerns but a part of the [skeletal] development of a child, which they will eventually outgrow," said Dr Preethamraj Vittal Salian , specialist in orthopaedics, Aster Clinic, Dubai Silicon Oasis.

He comes across these cases very frequently, he says, but has mostly had to assure parents that they do not require treatment. "Only a few cases require special attention," Dr Salian said.


As the name of the condition suggests, in-toeing, which is the pointing of toes inward, is one of the extremely common conditions found in babies and young children, according to Dr Salian, and it is most commonly observed in children below two years of age. In-toeing can be diagnosed without the need of an X-ray or scan.

"Children are born with in-toeing based on the way they are curled up in the womb, so there is nothing much for parents to worry about if they notice their child walking slightly differently. Once the child starts walking and running in the first year, the condition begins to improve."

However, Dr Salian pointed out that parents would still need to keep a watch on the improvement being made. "A child below the age of eight does not require treatment, but when the child begins to experience pain or discomfort, which occurs in rare cases, special braces, casts or corrective behaviour mechanisms might be required. If it persists till 10 years, surgical intervention might be required."

Bow legs and knock knees

In their first year of life, almost all children are bow-legged or knock-kneed, according to doctors. Bow legs make the knees appear wide apart and the legs look like a circle, while knock knees is a condition which makes the knees appear to bend inward towards each other.

"These conditions become noticeable once the child begins standing or walking. Normally, the legs tend to get corrected within a maximum of three to four years without any treatment," said Dr Salian. "It's normal for parents to be concerned about the deformed shape of legs of their child, but a slight degree of bowing or knocking is normal."

Observation while allowing time for the legs to get corrected with age is the only treatment, he added. "Medical intervention is required in such cases when the child's knee is excessively angled inward or outward and has unequal knee angles. If your child complains of pain or discomfort connected to the knee, ensure the condition is checked with a specialist."

A few signs to keep note of, according to Dr Salian, in order to understand if these conditions are indicative of a serious underlying condition are if only one side of the leg is affected, if there is an extreme curve inward or outward, or if bow legs and knock knees persist after two and seven years of age, respectively.

Dr Zaid Al Aubaidi , consultant paediatric orthopaedic and paediatric spine surgeon, says he consults cases like these several times a week and sometimes refers to them as "worried parent syndrome".

"We call these non-disease or non-concerning conditions in children. There can be mild differences from one child to another," he said.

"Parents should involve their kids in a lot of sports activities and leave their kids to have a normal growth. If children do not outgrow knock knees or bow legs, it can affect the child's activity level, which is why parents should keep an eye on the progress of each condition."

Dr Al Aubaidi pointed out that excessive deformity caused by knock knees and bow legs can affect the child's running and could also have a bad long-term effect on the knees. Surgical intervention is required depending on the nature of the deformity and the age of the child.


Flat feet is yet another condition noticed in children, where the child's foot sits flat on the ground when they stand and the curve in the middle disappears, according to specialists.

Dr Salian says this is the only condition that doesn't correct itself with time but does not require any treatment unless it results in pain or decreased movement or abilities.

"Most of the time, people develop arches on their feet during childhood but in some cases they don't at all and they just live with it," he said.

He explained that flatfeet can be of two types: rigid and flexible. Rigid flatfeet is caused due to abnormal development in the feet and is much more serious than flexible flatfeet. Rigid flatfeet may require surgical intervention to correct them. On the other hand, flexible flatfeet require no treatment.

Parents should be aware of the kind of flatfeet their children have and the degree of arch in their child's feet, Dr Salian advised. "In case a child faces pain or difficulty in performing certain activities, we recommend support using appropriate shoes. In rare cases, children require surgery to correct their rigid flatfeet and relieve pain," he said. To undergo a surgery, the child has to be at least eight years of age.

Children with flatfeet will be asked to wear a soft orthotic in their show for six hours a day in order to reduce pain. "If a child is overweight, regular exercise must be made a part of routine to maintain optimum weight. The shoes that children with flatfeet wear must be soft and flexible in order to provide the required support and development of arches," he further explained.

Both doctors emphasised the need for parents to track if the child's condition is progressing or deteriorating and to be aware of any difficulties or discomfort experienced by their children.

"Upon observing any severity in these conditions, a specialist must be consulted in order to advise you on the next feasible treatment options for the child," said Dr Salian.

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Publication:Gulf News (United Arab Emirates)
Date:Oct 6, 2017
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