Understanding Limb Deformities: Insights from Dr. Jacqueline Hill

Welcome back to the UCSF Sports Medicine podcast, Six to Eight Weeks, with your hosts, Dr. Nirav Pandya and Dr. Brian Feeley. As always, we’re here to give you expert insight into the latest in sports medicine and orthopedic care. Today, we’re thrilled to have one of our newest faculty members at UCSF, Dr. Jacqueline Hill, who is a world-renowned expert in limb deformity and limb lengthening. We’ll be diving into the complexities of limb deformity surgery and giving you the answers to questions you may not even know you had. Let’s get started.

Limb deformity occurs when bones don’t grow in the right direction or at the same rate, leading to issues such as bow-legged or knock-kneed appearances, or even noticeable differences in leg length. For children, this misalignment may affect their ability to walk or move comfortably, while in adults, it can lead to early arthritis or joint pain.

In young patients, growth plate manipulation is often used to correct these deformities. A small plate can be placed on the growth plate to encourage the bones to grow straighter over time. For adults, where growth plates have closed, more advanced techniques, like cutting and realigning the bones (osteotomy), are used to correct deformities. In cases where the deformity is more severe, external devices may be used to gradually straighten or lengthen the bones.

One of the most common questions parents ask is, “How do I know if my child’s bow-leggedness or knock-kneed appearance is normal?” According to Dr. Hill, limb alignment is a constantly changing target in growing children. Most children are bow-legged until around the age of two, after which their legs straighten out and eventually become knock-kneed by the age of seven. By adulthood, legs should have reached their final alignment.

When it comes to leg-length discrepancies, Dr. Hill emphasizes that any difference less than two centimeters is considered normal. In such cases, no treatment is usually necessary. If the discrepancy exceeds two centimeters, a simple shoe lift can often help without restricting activities. However, for more significant differences or severe bowing, early medical evaluation and potential intervention are recommended.

Dr. Hill explains that there are various surgical tools used to correct bone deformities, depending on the severity of the case. For minor misalignments, plates or internal rods can be used to correct the problem. In more severe cases, a fixator—a frame outside the body that slowly corrects the alignment—might be necessary.

These techniques not only help correct the deformity but also prevent long-term issues like arthritis, which can develop when misaligned bones put extra stress on joints. This is especially important for active children and adolescents, as continued physical activity without correcting the underlying issue can exacerbate the damage.

Interestingly, limb lengthening has also gained popularity in adults who seek to increase their height for cosmetic reasons. While this might seem unusual in orthopedics, Dr. Hill points out that many individuals experience what is known as “height dysphoria,” where their height negatively impacts their self-esteem and daily lives. Through surgery, these patients can gain two to three inches in height, although the procedure is complex and comes with risks. Nonetheless, for some individuals, the psychological benefits make the surgery worthwhile.

Another area of Dr. Hill’s expertise is in treating post-traumatic deformities—cases where bones don’t heal properly after a fracture. Sometimes fractures don’t heal in the right position, leaving the bones crooked or shortened. Fortunately, modern limb deformity treatments offer solutions to correct these problems and restore normal function. These interventions are especially important for children, where the potential for continued bone growth can be used to guide the healing process.

Limb deformity, whether present from birth or caused by trauma, can have profound effects on a person’s quality of life. Thanks to advances in orthopedic surgery, patients can regain normal limb function, whether through growth plate manipulation in children or complex osteotomies in adults. Dr. Jacqueline Hill’s expertise at UCSF highlights the importance of early diagnosis and the range of treatment options available for patients with these conditions.

For those dealing with limb deformity, consultation with an orthopedic specialist can open up possibilities for treatment and, in many cases, full correction of the deformity, allowing patients to live active and fulfilling lives.