Last year I went to a different rheumatologist in a different state because of knee pain no one could explain. Again, the doctor did the same thing. I was so shocked I could barely talk. I walked out of his office after he left me feeling angry.

I live in a rural area where doctors are limited. How do I talk to doctors that put me down like that? Both were average looking and not anything special. So where do they get off putting a patient down? I see other people on the street who can barely walk that are far worse off than me in that department.

Thank you for your time on this matter.

DEAR READER: Bow legs were not your choice. They either developed physiologically or pathologically. Generally speaking, physiologic bowing improves without treatment as a child grows. Unless treatment is given, pathologic bowing, which is due to a disease process, tends to worsen as a child grows.

Most babies are born with bowed legs because of the way an infant is curled up during the nine months a woman carries it. By about 18 months of age, the bowing self-corrects. By the age of 3 or 4, a knock-kneed alignment occurs. This, in most instances, corrects to some degree by the age of 5 or 6. There are occasions, however, when the bowing never fully corrects, and this is the reason some adults have bowed legs.

A number of diseases can cause pathologic bowing, with two of the more common ones being rickets and Blount’s disease.

Rickets results from a dietary deficiency of vitamin D, calcium and phosphorus. This is relatively uncommon in the United States because of vitamin supplements and diet but is still seen in less developed countries. It should be noted that even with a normal intake of vitamin D, a breakdown in the mechanism that uses vitamin D in the body can cause a rickets syndrome. The disorder causes cupping and widening of the growth plates that can be identified on a simple X-ray. Symptoms include bow legs and knock knees, swelling at the ends and sides of the bones, muscle pain, curvature of the spine, enlarged liver and spleen and a host of other conditions.

Blount’s affects the inner edge of the upper shin bone at the knee growth plate. It runs across the knee, causing a decrease in the growth plate closest to the leg’s inner side or inseam. The outside portion of the growth plate grows normally, which leads to bowing. The disease affects infants and teens. Both groups have a similarity in that the children are overweight for their age. The deformity is always tied with an inward direction of the foot and ankle. If detected early enough, braces can help. Diagnosis, as with rickets, can be made by X-ray, but simple positioning of the foot, not the knee, is critical for proper diagnosis.

Now, on to your less-than-professional medical contacts. I have no idea how bowed your legs are, but there is simply no excuse for such shenanigans by a physician, whether at Mayo Clinic or the walk-in clinic on the corner in a small town. You were treated poorly. You cannot do anything about the inadequacies of such uncaring, bumbling individuals. If it ever happens again, simply inform him or her that you did not leave a side show to provide entertainment for the viewer: You expected to be treated with dignity. No matter how hard this might be, toughen up and don’t let another person get the upper hand. Were it me, I certainly would never expect to see a bill for services rendered. Laughter should be free and enjoyed by everyone involved.

Request a referral to an orthopedic specialist and get the answers you should have received 10 years ago. Good luck, and remember — hang tough! You can do this.

To provide related information, I am sending you a copy of my Health Report “Medical Specialists.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.