Lower Limb Deformities - Comprehensive Treatment
Genu varum and genu valgum, leg length discrepancy, increased anteversion of the femoral neck, or tibial torsion—precise diagnosis and personalized treatment of lower limb alignment disorders in children and adults.
What are limb deformities?
Lower limb deformities are anatomical abnormalities that affect the proper alignment, length, and rotation of the legs. They can be congenital or acquired—in both cases, early diagnosis and appropriately selected treatment are crucial for maintaining proper gait biomechanics and preventing secondary degenerative joint changes.
Reasons
Congenital defects (e.g., femoral hypoplasia) and acquired defects resulting from chronic postural abnormalities, injuries, metabolic disorders, or rheumatic diseases.
Symptoms
Uneven leg lengths, “X”- or “O”-shaped knees, inward or outward rotation of the feet, pain, increased fatigue, and instability while walking.
Diagnostics
Clinical evaluation and gait analysis, teleradiography of the entire lower extremities, and, in selected cases, ultrasound, CT, or MRI.
An experienced team and personalized treatment plans
We begin treatment of limb alignment deformities with a detailed analysis of the biomechanics of the musculoskeletal system—we assess not only the knee joint but also the alignment of the pelvis, hips, and feet in order to precisely plan a treatment tailored to each specific case.
80 countries from which patients come
The 6 main categories of limb deformities we treat
2 centers: orthopedics and neuroorthopedics in Warsaw
When should you see a specialist?
In infants and young children:
Visible asymmetry in leg alignment, shortening of one limb, or asymmetry in the skin folds of the thigh.
Genu varum or genu valgum persisting beyond 3–4 years of age, requiring differentiation from a physiological abnormality.
A "waddling" gait or a pronounced inward rotation of the feet while walking.
For older children and adults:
Pain in the knees or hips while walking, running, and after prolonged physical activity.
A feeling of joint instability, limited range of motion, and legs that tire more quickly.
Characteristic, uneven wear on one side of the shoes.
How do we treat lower limb deformities?
We provide treatment in stages—from thorough diagnosis, through conservative or surgical treatment, to rehabilitation and long-term care.
Diagnostics and Planning
A clinical examination, gait analysis, and teleradiography of the lower extremities allow for an accurate determination of the type and degree of deformity.
Conservative treatment
Customized physical therapy, orthotic insoles, and braces; in children, many conditions correct themselves as they grow older.
Surgical treatment
The Guided Growth method, corrective osteotomy, or limb lengthening, tailored to the patient’s age and the severity of the deformity.
Rehabilitation
A rehabilitation program that includes regaining mobility, rebuilding muscle strength, and learning proper gait patterns.
Types of Lower Limb Deformities
Bowlegs (Genu valgum)
An “X”-shaped stance—with the knees close together and the ankles apart—can lead to overexertion and degenerative changes.
Bowlegs (Genu varum)
The opposite of knock-knees—the ankles touch each other, while the knees remain apart, forming an “O” shape.
Leg Length Discrepancy (LLD)
Leg length discrepancy is assessed using, among other methods, the Paley multiplier. Treatment is tailored to the extent of the discrepancy, ranging from observation to limb lengthening.
Tibia Torsion (Tibial Torsion)
Abnormal axial rotation of the tibia causing compensatory overloading of the knee and ankle joints.
Increased anteversion of the femoral neck
Excessive forward torsion of the femoral neck, causing an “in-toeing” gait and limiting external rotation.
Congenital Femoral Hypoplasia (CFD / PFFD)
A congenital disorder that is more common in girls and can be diagnosed in newborns—it requires early, comprehensive treatment.
Paley European Institute: A global standard in Poland
As an integral part of the Paley Institute’s global network, we provide access to the most advanced osseointegration systems, based on standardized and proven medical protocols.
A global network, one standard (Unified Protocol)
We operate within the strict framework of the Paley Institute, which means that every stage of your treatment—from the initial consultation to the final rehabilitation—follows the same rigorous guidelines as in our centers in the U.S. and the United Arab Emirates.
Direct Expertise from the Pioneers
Our team, led by Dr. Karolina Siwicka, MD, PhD, directly carries on the legacy of Prof. Munjed Al Muderis. Dr. Siwicka is implementing her own surgical techniques in Poland, which have revolutionized modern osseointegration worldwide.
Certified safety and innovation
We use only genuine, clinically proven, and CE-certified OPL implants. Thanks to the constant exchange of expertise within our network, we follow up-to-date protocols based on medical evidence, so you can be confident that your treatment is in line with the latest scientific knowledge and is performed in a predictable and consistent manner.
Scientific Articles: Deformities of the Lower Limbs
https://pubmed.ncbi.nlm.nih.gov/?term=Paley+Correction+of+Limb+Deformities+in+the+21st+Century
https://pubmed.ncbi.nlm.nih.gov/?term=Paley+Tetsworth+Mechanical+Axis+Deviation+Lower+Limbs+1992
https://pubmed.ncbi.nlm.nih.gov/?term=Herzenberg+Correcting+Torsional+Deformities+Ilizarov+1994
https://doi.org/10.1302/0301-620X.94B9.28672
Our Doctors Meet the Paley European Institute team
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Your most frequently asked questions
That is, What you as a parent should know before making a decision.
In genu valgum (knock-knees), the knees come together while the ankles remain apart, resulting in a “X”-shaped leg alignment. In genu varum (bowlegs), the opposite occurs—the ankles touch while the knees remain apart, forming an “O” shape. Both conditions require different treatment plans.
No. Between the ages of 2 and 4, a certain degree of valgus or varus deformity is physiological and usually resolves on its own as the child grows. Only persistent deformities, those that worsen, or those associated with other medical conditions require treatment—which is why observation and consultation with an orthopedist are crucial.
This is a minimally invasive method for correcting limb alignment in children and adolescents during their growth period, involving the temporary fixation of the growth plate on one side of the bone using a small plate. The procedure is performed through two incisions measuring a few millimeters each, allowing the child to quickly return to normal activities.
The basis is teleradiography (an X-ray of the entire lower extremities in a standing position), which allows for the precise measurement of the length of the femur and tibia. The Paley multiplier method, which predicts the final difference in leg length after growth is complete, is helpful in planning treatment for children.
Differences of up to 2 cm usually do not require surgery—monitoring or a heel insert is sufficient. Differences ranging from 2 to 5 cm are treated, among other methods, by slowing the growth of the longer limb (epiphysiodesis) in children during their growth period. Differences greater than 5 cm are an indication for surgical lengthening of the shorter limb.
This is an excessive forward rotation of the femoral neck, which causes a characteristic “in-toeing” gait—the feet and knees are positioned in internal rotation. In children, this condition often corrects itself with age; in more severe cases, a corrective osteotomy is performed.
Not always. Mild cases are managed with observation and physical therapy. When an abnormal axial rotation of the tibia causes significant compensatory stress on the knee or ankle joint, a corrective osteotomy is performed in combination with internal or external stabilization.
A patient- and family-centered approach
Osseointegration treatment is not just a surgical procedure, but also a process that requires support on many levels—physical, emotional, and social. That is why at the Paley European Institute we use a Family-Centered Care model, in which the patient and their loved ones are an active part of the entire treatment process.
A team of specialists—including surgeons, physical therapists, psychologists, and prosthetists—works together to provide comprehensive care before surgery, during treatment, and throughout rehabilitation. Patients and their families receive clear information about every stage of treatment, which helps them make informed decisions and reduces the stress associated with treatment.
We also place a strong emphasis on psychological support and preparing the patient to live with a prosthesis following osseointegration. This ensures that the adaptation process proceeds safely, allowing the patient to gradually regain independence and confidence in their daily activities.
This approach allows us to take a holistic view of treatment—not just as a surgical procedure, but as a path to improving the quality of life for the patient and their family.
