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Bow Legs (Genu Varum): Causes & Treatment

Bow legs (genu varum) are a leg axis deformity in which the knees point outward. They can be congenital, growth-related, or caused by underlying medical conditions.

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Things worth knowing about "Bow legs"

Bow legs (genu varum) are a leg axis deformity in which the knees point outward. They can be congenital, growth-related, or caused by underlying medical conditions.

What are Bow Legs?

Bow legs, medically known as genu varum, are a deformity of the leg axis in which the knees deviate outward while the feet are placed together. This creates a characteristic curved shape resembling the letter “O”. A mild degree of bowing is normal in infants and toddlers up to about two years of age and typically resolves on its own as the child grows.

Causes

Bow legs can result from a variety of causes:

Physiological development: Mild bowing is normal in newborns and young children and usually corrects itself by school age.
Rickets: A deficiency of vitamin D leads to softening of the bones and can cause pronounced bow legs.
Blount disease: A growth disorder of the shinbone (tibia) that particularly affects overweight children.
Osteoarthritis: Degenerative cartilage loss in the knee joint can lead to a varus deformity in adults.
Bone diseases: Conditions such as osteogenesis imperfecta or bone tumors can contribute to bow legs.
Injuries: Poorly healed fractures or growth plate injuries can result in a varus deformity.
Obesity: Excess body weight places increased stress on the knee joints and can worsen an existing deformity.

Symptoms

Mild bow legs often cause no discomfort. In more pronounced cases, the following symptoms may occur:

Visibly curved or bowed appearance of the legs
Knee pain, especially during walking or physical activity
Pain in the hip or ankle region
Altered gait pattern
Increased load on the inner compartment of the knee, promoting osteoarthritis
Leg fatigue during prolonged standing or walking

Diagnosis

Bow legs are primarily diagnosed through a clinical examination. The physician assesses the leg axis while the patient stands and walks. Additional diagnostic measures include:

X-ray: To precisely measure the varus angle and evaluate bone and joint structures.
Gait analysis: To assess loading patterns and compensatory movements.
Blood tests: To rule out metabolic disorders such as rickets or other underlying conditions.
MRI or CT scan: If structural cartilage or bone damage is suspected.

Treatment

Treatment depends on the underlying cause, the age of the patient, and the severity of the deformity:

Conservative Treatment

Physiotherapy: Targeted muscle training to stabilize the knee joints and improve leg alignment.
Insoles: Orthopedic shoe insoles can improve load distribution and relieve discomfort.
Orthoses: In children, braces or orthoses can guide bone growth in the correct direction.
Weight reduction: In cases of obesity, weight loss is recommended to relieve joint stress.
Vitamin D and calcium supplementation: When rickets is the underlying cause, treating the vitamin D deficiency is essential.

Surgical Treatment

Corrective osteotomy: Surgical correction of the leg axis by precisely cutting and realigning the bone.
Epiphysiodesis: In children, selectively slowing bone growth on one side can allow self-correction over time.
Knee replacement: In adults with severe osteoarthritis, a total knee replacement may become necessary.

References

Hefti, F. - Pediatric Orthopedics in Practice. Springer, 3rd edition, 2015.
Staheli, L. T. - Practice of Pediatric Orthopedics. Lippincott Williams & Wilkins, 2006.
American Academy of Orthopaedic Surgeons (AAOS) - Bow Legs (Genu Varum). URL: https://www.aaos.org

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