GENU VARUM

INTRODUCTION
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.
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.
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.
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.
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.
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.
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.
• 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.

• 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.
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.