These objective symptoms in children are accompanied by much complaint of fatigue and discomfort, and by pain in case of overstrain.
The diagnosis is easily made after examination. It is important always to think of a case of genu valgum when parents bring their children to the physician with the complaint that they walk with their feet turned in.
Treatment includes chiefly two points for consideration in small children: 1. Prophylaxis.
2. Spontaneous recovery.
Small children with soft bones must not be carried around, for the arms of the nurse may deform the bones. A reclining position either on the back or the stomach must be favored, and circular as well as lateral elastic traction must be avoided. I employ garters at the back and the inside. The front ones very often cause extensions. As soon as a valgus deformity is noticeable parent and physician should give up hope of spontaneous recovery.
How do rachitic deformities heal? Nature invariably tries to over come one curvature with a compensatory second curvature. In knock knee a child attempts by inward torsion of the foot to avoid the angle formed by the knee and to bring the feet nearer to each other. Thus an inward curvature of the leg is developed. Frequently we find traces of old knock-knee in the form of knees bent markedly inward with a peculiar correcting curvature of the tibia inward, and just below a sign of correction which had taken place earlier. Nature occasionally goes too far—an original yarns deformity of the femur (bow-leg) may be compensated during further growth by a genu valgum, to be again rected by a compensatory curvature of the leg (observed by the author). All these corrections take place only when the softness of the hones has not become too extreme or the deformity too pronounced. wise any further weight inemases the deformity. Spontaneous recovery must be aided in every way and not prohibited by the introduction of "modern" cosmetic appliances by interfering and unreasonable parents. To insist that children who walk with feet turned in should favor a gait with the feet turned outward is only aiding the development of genu valgum. After the elimination of genu valgum, walking with feet turned
inward disappears of its own accord. It is more important to see that children stand with the heels touching each other, because with the feet wide apart the great weight component tends to increase the deformity (see Etiology).
In order to employ correct therapeutic measures we must distin guish the genu valgum of early childhood from that of a later period and also take into consideration the social condition in cases of prolonged treatment.
Tn small children, static treatment and exercise arc to be preferred.
A drawing of the contours in the recumbent position and frontal fixation of the axes of the knees permit an accurate judgment of the actual condition. Arch supporters of celluloid and steel wire or eleva tion of the inner side of the sole forces the foot into a supinated position and separates the knees.
The preparation of arch supporters made of celluloid and steel wire is described on page 187 (Fig. 106). If reduction exercises and gymnastics with weights are added, recovery may he expected, providing the cases are not too severe. In mild eases splints arc superfluous. After three months a drawing of the contours is made to find out whether or not improvement has taken place. Tn nearly all cases a decrease in the deformity is observed.
In pronounced cases, or in cases not benefited by the above men tioned measures, I would choose a thorough correction by operation or by the bloodless method in preference to a treatment by splints covering several years.
A reducing plaster-of-Paris bandage, in combination eventually with a preceding epiphyseotomy or osteotomy, will eliminate the deform ity. The plaster bandage maintains the legs in correct position until recovery, and light splints may be employed in the after-treatment.
In treating genu valgum in older children Wolff used a series of temporary bandages with which correction is attained in a bloodless manner.