What is deformity? What are the causes?

Deformity is a general term for curvature and deformity of bones. Knee deformities, commonly known as “O” or “X” legs, are one of the most common causes of paediatric orthopaedic clinics. In addition, deformities involving the hips, feet and upper limbs occur.

These deformities should be assessed in detail and it should be determined whether it is a condition that occurs in the course of normal growth or whether it is caused by other conditions, such as underlying trauma, vitamin deficiencies and so on. For example, in the case of deformities that usually occur during postnatal walking, it is known that these deformities will improve over the next few years and can therefore be followed up without the need for the child to be placed on a special device. However, for deformities that appear especially after trauma and do not improve after a long time, there is no treatment other than surgery. In addition, this deformity, which we call pathological, may cause problems in the future because the load distribution in the knee, hip and ankle joints is disrupted and therefore needs to be corrected.

Many deformities are congenital. Deformities that develop later in life are usually associated with diseases and traumas that impair bone mass. The most common of these is rickets, which occurs in the presence of vitamin D deficiency. Happily, however, when such individuals are supplemented with vitamin D, the problem is largely resolved and the patient does not need to undergo major surgery. Preventive measures are necessary in due course in the case of some congenital diseases and in the case of curvatures which increase during the growth period of children.

There are several stages in the normal development of a child’s legs. When they first start walking, children’s legs are “O” shaped. The appearance of the legs begins to improve as the walking speed increases, improves completely after the age of three, and the legs reach an adult appearance after the age of five. Normal development continues in this way. Families usually present to the clinic when their child first starts walking, during the period of normal leg flexion or pronation. It is necessary to inform the family and reassure them if there are no problems with the joint areas, if the child’s general health is good, if nutrition is appropriate, and if no development-related problems have been brought to the attention of the paediatrician; since it is well known that leg curvature is almost completely corrected, and for these patients waiting is sufficient.

To illustrate what families should be aware of with their children, families can look to see how many fingers are in the gap between their child’s knees when the child has his or her legs together and is in the ready position. If this gap is three fingers, they can watch to see if it decreases to two fingers in six months and if it gradually improves. Families who come to the clinic are told how to follow up. They are asked to take measurements every three to six months. If necessary, necessary tests (such as X-rays) are also performed and a detailed assessment is made.

In adults, deformities can be seen as a result of previous illness or trauma. These deformities are seen in all parts of the body, at all angles and directions. Treatment of adult deformities is usually performed surgically because skeletal development has been completed. At this point, the degree to which the existing deformity affects the patient’s daily life, function, and appearance should be evaluated and the surgical decision made accordingly.