Genu varum, also known as bow legs, is a physical deformity where the legs curve outward from the thighs. It can occur in children due to normal development or due to conditions like Blount's disease or rickets that affect bone growth. In children, genu varum is often monitored and may resolve on its own, while more severe cases or those caused by underlying diseases may require bracing or surgery to correct alignment and prevent long-term issues. Surgical options aim to stop abnormal bone growth or reshape the shinbone to straighten the legs.

1. GENU VARUM
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2. CONTENTS
• INTRODUCTION
• CAUSES
• CLINICAL FEATURES
• EXAMINATION
• TREATMENT
• REFERENCES
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3. INTRODUCTION
• The three common deformities are genu varum
(bow leg) genu valgum (knock knee) and genu
recurvatum (hyperextended knee).
• Genu varum is also called bow leg or tibia vara is a
physical deformity marked by (outward) bowing of
the leg in relative to the thigh, giving the
appearance of an archer’s bow.
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4. CAUSES
• Physiological/developmental
• commonly occurs in childhood.
• Bowed legs in a toddler is very common. When a
child with bowed legs stands with his or her feet
together, there is a distinct space between the
lower legs and knees. This may be a result of either
one or both of the legs curving outward. Walking
often exaggerates the bowed appearance.
• gradually corrected spontaneously as the child
grows.
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5. Pathological
• Genu varum may also occur in adults.
• In both children and adults it may occur as a
consequence of injury or disease.
• Disorders which cause distorted epiphyseal and/or
physeal growth may give rise to bow leg or knock
knee;
• these include some of the skeletal dysplasias and
the various types of rickets, as well as injuries of
the epiphyseal and physeal growth cartilage.
• A unilateral deformity is likely to be pathological.
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6. Blount’s Disease
• can occur in toddlers as well as in adolescents.
• results from an abnormality of the growth plate in the upper part
of the tibia.
• Growth plates determine the length and shape of the adult bone.
In a child under the age of 2 years, it may be impossible to
distinguish infantile Blount’s disease from physiologic genu
varum.
• By the age of 3 years, however, the bowing will worsen and an
obvious problem can often be seen in an X-ray.
• Progressive; associated abnormal growth of the posteromedial
part of the proximal tibia.
• The condition is bilateral in 80% of cases and black children are
affected more. The condition is noticeably worse than in
physiological bow legs and may include internal rotation of the
tibia.
• Spontaneous resolution is rare.
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A child with Blount’s disease…
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8. Rickets
• bone disease in children that causes bowed legs
and other bone deformities.
• Children with rickets do not get enough calcium,
phosphorus or vitamin D.
• Nutritional rickets unusual in developed countries.
• can also be caused by a genetic abnormality that
does not allow vitamin D to be absorbed correctly.
This form of rickets may be inherited.
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9. In adults…
• common in adults.
• may be sequel to childhood deformity and if so usually
cause no problems.
• However, if the deformity is associated with joint instability,
this can lead to osteoarthritis of the medial compartment.
• Other causes include:
• Fracture of the lower part of the femur or the upper part of
the tibia with malunion.
• Osteoarthritis
• Rarefying diseases of the bone such as rickets or
osteomalacia.
• Other bone-softening diseases such as Paget’s disease
(osteitis deformans)
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10. Clinical features
• deformity is usually gauged from simple observation.
• Bilateral genu varum can be recorded by measuring the
distance between the knees with the patient standing
and heels touching.
• Internal rotation is also common in toddlers and
frequently occurs in combination with bowed legs.
• The deformity typically do not cause pain.
• During adolescence/adulthood however, persistent
bowing can lead to discomfort in the hips, knees,
and/or ankles because of the abnormal stress that the
curved legs have on the joints.
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Medial compartment in a varus
deformity…
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12. Examination
• should begin with a thorough history taking.
• followed by a careful physical assessment to exclude
underlying organic disorders; if necessary by radiographs.
• If the patient is under 2 1/2 and has symmetrical bowing, an
X-ray may be required. The likelihood of having Blount’s
disease or rickets is greater at this age.
• In Blount’s disease, the proximal tibial epiphysis is flattened
medially and the adjacent metaphysis is beak-shaped. The
medial cortex of the proximal tibia appears thickened. This
is an illusory effect produced by internal rotation of the
tibia.
• In contrast to physiological bowing, abnormal alignment
occurs in the proximal tibia and not in the joint.
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Physiological… Pathological…
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14. Treatment
• Physiologic genu varum nearly always spontaneously
corrects itself as the child grows.
• This usually occurs by the age of 3 to 4 years.
• Blount’s disease does not require treatment to
improve. If the disease is caught early, treatment with
brace may be all that is needed.
• Bracing is not effective however with adolescents with
Blount’s disease.
• Untreated infantile Blount’s disease or untreated
rickets results in progressive worsening of the bowing
in later childhood and adolescence.
• For children with rickets, the condition can be managed
with medications.
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15. Surgical Treatment
• Physiologic genu varum
• In rare instances, physiologic genu varum in the
toddler will not completely resolve and during
adolescence, the bowing may cause the child and
family to have cosmetic concerns.
• If the deformity is severe enough, then surgery to
correct the remaining bowing may be needed.
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16. Surgical Treatment Cont’d
• Blount's disease. If bowing continues to progress in a
child with infantile Blount's disease despite the use of a
brace, surgery will be needed by the age of 4 years.
Surgery may stop further worsening and prevent
permanent damage to the growth area of the
shinbone.
• Older children with bowed legs due to adolescent
Blount's disease require surgery to correct the problem.
• Rickets. Surgery may also be needed for children with
rickets whose deformities persist despite proper
management with medications.
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17. Surgical Procedures
different procedures; two main types.
• Guided growth. This surgery of the growth plate stops
the growth on the healthy side of the shinbone which
gives the abnormal side a chance to catch up,
straightening the leg with the child’s natural growth.
• Tibial osteotomy. In this procedure, the shinbone is cut
just below the knee and reshaped to correct the
alignment.
• After surgery, a cast may be applied to protect the bone
while it heals.
• Crutches may be necessary for a few weeks, and
exercises to restore strength and range of motion.
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Before… After…
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19. References
• Bowed Legs Reviewed by members of POSNA
(Pediatric Orthopaedic Society of North America) @
http://orthoinfo.aaos.org/topic.cfm?topic=a00230
Accessed on 01/04/2015.
• Hamblen, D. L., & Simpson, H. (2009). Adams's
outline of orthopaedics. Elsevier Health Sciences.
• Solomon L, Warwick D, & Nayagam S. (Eds.). (2010).
Apley's system of orthopaedics and fractures. CRC
Press.
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20. THANKS ALL!
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