by Matthew Harris MD, MBA
Many adults suffer limb deformities of one type or another. Some are more recognizable than others, such as being "knock-knee'd" (genu valgum) or "bow-legged" (genu varum). Then there are the deformities that are more subtle, such as walking "duck footed" (excessive retroversion and external torsion) or "pigeon-toe'd" (excessive anteversion and internal torsion). These tend to be more subtle because patients will often be cognizant of their deformity and will purposefully walk in a way that masks it, unlike being "knock knee'd" or "bow legged" which there is no way to hide, aside from wearing a pair of baggy pants.
Apart from the embarrassment that often accompanies these deformities, patients will notice that they develop PAIN in the affected joints as well. What is most concerning is that this pain can be from simply exercising or going about your normal daily activities, and it tends to present at a much earlier age than you find that your friends will experience. Our bodies sometimes develop in ways that they were not originally designed to, and over time, these deformities lead to excessive wear and tear on our joints. Before we know it, we're feeling the warning signs of Early Arthritis. The goal is to identify deformities, and treat them before they cause irreversible joint damage. All too often, patients ignore their symptoms and wait until it is too late...and by that point they have left themselves few options but to undergo a joint replacement surgery. To read more on Dr. Harris's discussion of Early Arthritis, and the dangers of joint replacement, click here.
The good news is that we have many ways to treat these deformities. We offer minimally invasive techniques, gradual correction, acute correction, internal correction and external correction. While every patient's deformity is different from one to the next, what holds true for everyone is that everyone wants their deformity to be fixed as quickly and accurately as possible so that they can get back to enjoying healthy, active lives without the pain.
An example of an external frame that can be used to not only straighten crooked bones, but also rotate them at the same time is shown here. By making gradual turns each day, little by little your legs or arms become perfectly straight. We of course guide you through this entire process, and while correction takes a bit longer to achieve with this method, some patients prefer it because it leaves behind much smaller scars than would otherwise be needed with an incision to go in, cut the bone, straighten it and then hold it in place with a plate and screws.
This patient arrived at the full correction after approximately 4 weeks. The frame then had to stay in place for another two months until the bone was healed completely before it could be removed. But the patient was happy that the only scars on her leg were not much bigger than the width of the pins and wires.
In comparison to to the external frame, an alternative is to make an incision, cut the bone and acutely straighten the leg before placing a plate and screws that are strong enough to allow for partial weight bearing immediately after surgery. There of course is no frame to worry about, and some patients say that an acute correction is more painful than doing so gradually, but all work is complete in just one surgery and all that is left to do afterwards is to heal the bone. Each of these procedures is called a High Tibial Osteotomy.
Dr. Harris performs these surgeries to treat Genu Varum in order to realign the knees so that all of your body weight and pressure gets distributed evenly throughout the knee joint and ankle joints. Walking with a deformity is no different than driving your car out of alignment with bent axles. Because the force is not evenly distributed, you end up wearing through the inside part of your tires rapidly. In this analogy, your tires are equivalent to the cartilage in your joints. Arthritis is the result of cartilage wearing away over time, and it is both painful and debilitating. We want to address the initial deformity before it comes to this. If not addressed soon, your surgery more complicated because we may then also need to to treat any damaged cartilage so as to help it regenerate, in addition to realigning your bones.
Limb deformity can just easily affect the Upper Extremities as well. The lower extremities tend to receive the lion's share of attention because we depend on them to walk and move around, and they also are responsible for carrying all of our body weight. For that reason, deformities of the lower extremities frequently lead to arthritis, whereas deformities of the upper extremities are more likely to functional limitations, or appear cosmetically unattractive, but rarely will lead to arthritis. Nevertheless, we utilize the same surgical techniques and principles to treat upper deformities as well.