Genu varum

Genu Varum

Genu varum

Genu Varum (GVR) is a knee disorder which may lead to outward bowing of the legs while standing, giving them the appearance of a bow. Find out all about the condition, including its symptoms, treatment and life expectancy.

Genu Varum Definition

It is a medical condition in which the knees of an affected individual are wide apart, while the ankles and feet are together when he/she stands up. This type of physical deformity is considered to be normal among children below 18 years of age. The condition can worsen due to excessive walking.

Generally, medial angulation of tibia and femur are included in the medical condition.

This form of physical deformity is known by many other names, :

  • Bandiness
  • Bow-leggedness
  • Bandy-leg
  • Tibia vara

Genu Varum Types

GVR is broadly classified into two main types, including:

Genu Varum Incidence

This medical condition generally affects infants between 1-2 years of age. When an affected infant starts walking, the bowed legs begin to straighten as they start taking body weight. Males are more prone to GVR then females.

Genu Varum Causes

Rickets are the primary cause of this physical deformity. Bow-leggedness remains persistent under the following conditions:

  • If a child is unwell due to rickets
  • If he or she is suffering from any disorder which restricts the ossification of the bones
  • If the child is not properly fed

In a few cases, infants suffer from one-sided bow-leg problems due to tumors, skeletal problems or infections. A few other possible medical disorders, which can lead to GVR in the body of the patient, may include:

  • Pseudoachondroplasia
  • Hyperostosis corticalis deformans juvenilis
  • Caffey’s disease
  • Camptomelic dysplasia
  • Osteofibrous dysplasia
  • Osteomalacia
  • Fibular hemimelia
  • Metaphyseal chondrodysplasia, Schmid type
  • Osteogenesis imperfecta
  • Osteoarthritis
  • Kyphomelic dysplasia
  • Achondroplasia
  • Blount’s disease
  • Vitamin C deficiency
  • Hypophosphatasia
  • Weismann-Netter-Stuhl syndrome
  • Paget’s disease of bone

Genu Varum Symptoms

Bandy-legs are evident from adolescence when an affected infant stands and begins to walk. The primary symptom of the disorder is a discomfited walking pattern. Bowed legs are quite common among toddlers.

 However, the degree of bowing sometimes alarms parents of affected infants to seek medical attention. Intoeing is quite common among toddlers and often occurs in association with bowed legs.

Bowed legs does not give rise to pain, however, persistent bowing can often give rise to discomfort in knees, hips and ankles.

Genu Varum Diagnosis

The diagnosis of bowed legs begins with proper physical examination of a suffering child. The space between the knees is measured in order to determine the intensity of the disorder. However, doctors may recommend blood tests in order to rule out the existence of rickets. X-rays are often recommended to GVR patients if:

  • The bowing deteriorates
  • Test results confirm the presence of any other disease
  • The infant is above 3 years of age
  • Bowing on both sides is not equivalent

Genu Varum Differential Diagnosis

The differential diagnosis of GVR includes distinguishing the symptoms of this disorder from those of similar diseases, such as:

  • Blount disease
  • Rickets
  • Tibial bowing

Genu Varum Treatment

In infants, GVR resolves with age. The correction generally initiates between 3-4 years of age. If GVR in infants become severe, it can be treated with:

Picture 2 – Genu Varum Image

Surgical Treatment

In rare cases, when GVR does not resolve completely, it gives rise to cosmetic concerns among parents of an affected kid. If the physical deformity is severe, medical surgery is often recommended to such patients to correct the bowing completely.

Non-Surgical Treatment

If bowing does not resolve within 6 months of its occurrence, doctors often recommend non-surgical procedures for such patients. These techniques include use of medicines and drugs.

Genu Varum Prognosis

The prognosis of the disorder is considered to be very good. Generally, patients encounter any problem during walking. However, in severe cases, sufferers often experience discomfort while walking.

Genu Varum Prevention

In order to avoid bowlegs, children must be prevented from rickets. Normal exposure to sunlight and adequate levels of vitamin D in the diet enables infants to prevent such disorders.

Genu Varum Complications

If GVR persists in the legs of patients, it may give rise to arthritis in the hips or knees in the due course. Hence, proper medical treatment should be availed in order to prevent the occurrence of the ailment.

Genu Varum is a common knee disorder causing physical deformity. Get in touch with your doctor for a diagnosis, if you experience the signs and symptoms of GVR. Parents of sufferers are highly recommended not to neglect the disorder and avail early treatment in order to avoid the occurrence of associated complications.


Treatment of Bow legs

Generally, no treatment is required for idiopathic presentation as it is a normal anatomical variant in young children. Treatment is indicated when its persists beyond 3 and half years old, Unilateral presentation, or progressive worsening of the curvature. During childhood, assure the proper intake of vitamin D to prevent rickets.

Mild degree of deformity can be treated by wearing surgical shoes with 3/8″ outer raised and with a long inner rod extending to the groin and leather straps across the tibia and the knee. Corrective operations can also be performed, if necessary. The person would need to wear casts or braces following the operation.

Post operative Physiotherapy

  • Gradual knee mobilization is the main part of the treatment.
  • Some heat modalities may be given for relief of pain.
  • Strengthening exercises for quadriceps, hamstrings and gluteus muscles are given.
  • When the patient is able to walk, he is given correct training for standing, balancing, weight transferring and walking.

Tibia Vara (Blount Disease)

Idiopathic tibia vara, or Blount disease, is the most common pathologic disorder producing a progressive genu varum deformity.

It is characterized by abnormal growth of the medial aspect of the proximal tibial epiphysis, resulting in a progressive varus angulation below the knee. Tibia vara can occur at any age in a growing child.

It is classified according to the age at clinical onset, as follows: infantile (1 to 3 years), juvenile (4 to 10 years), and adolescent (≥11 years).

The infantile group is the most common; the juvenile and adolescent forms typically are combined as late-onset tibia vara, which occurs much less frequently. Etiology Although the exact cause of tibia vara is unknown, it seems to be secondary to growth suppression from increased compressive forces across the medial aspect of the knee.

Clinical Manifestations

The characteristics of infantile tibia vara include predominance of black race, female gender, marked obesity, approximately 80% bilateral involvement, a prominent medial metaphyseal beak, internal tibial torsion, and lower extremity length inequality.

Characteristics of the juvenile and adolescent (late-onset) form are black race, predominance of males, marked obesity, approximately 50% bilateral involvement, slow progressive genu varum deformity, pain rather than deformity as the primary initial complaint, no palpable proximal medial metaphyseal beak, minimal internal tibial torsion, mild medial collateral ligament laxity, and mild lower extremity length inequality. The differences between the three tibia vara groups seem to be related primarily to the age at clinical onset, the amount of remaining growth, and the magnitude of the medial compression forces on the involved side. The infantile-onset group has the potential for the greatest deformity, and the adolescent-onset group has the least.


Radiographic Evaluation Standing anteroposterior and lateral radiographs of the lower extremities are necessary to assess pathologic genu varum deformities.

Radiographically, fragmentation with a protuberant step deformity and beaking of the proximal medial tibial metaphysis are considered the major features of infantile tibia vara.

The changes of the proximal medial tibia are less conspicuous in the late-onset forms and are characterized by wedging of the medial portion of the epiphysis, a mild posteromedial articular depression, a serpiginous cephalad curved physis of variable width, and mild or no fragmentation or beaking of the proximal medial metaphysis. The major deformity that must be differentiated from infantile tibia vara is the physiologic genu varum deformity. It is difficult to differentiate radiographically between these two disorders in children younger than 2 years old.


When the radiographic findings confirm the diagnosis, treatment should begin immediately. Orthotic management may be considered for children 3 years or younger with a mild deformity. Approximately 50% of children with this criterion may achieve adequate correction using orthoses. Conservative management in the late-onset forms of tibia vara is contraindicated.

The children are too large, compliance is poor, and the remaining growth is too small to allow for adequate correction. The indications for surgical treatment in infantile tibia vara include 4 years of age or older, failure of orthotic management, and moderate to severe deformity.

Proximal tibial valgus osteotomy with associated fibular diaphyseal osteotomy is the procedure of choice.

Further Reading

  • Genu-varum. From Wikipedia, the free encyclopedia [Wikipedia]
  • Pediatric Genu-Varum .
  • Bowed Legs.
  • Brooks WC, Gross RH. Genu-Varum in Children: Diagnosis and Treatment. J Am Acad Orthop Surg. 1995 Nov;3(6):326-335.

  • Ballal MS, Bruce CE, Nayagam S. Correcting genu varum and genu valgum in children by guided growth: temporary hemiepiphysiodesis using tension band plates. J Bone Joint Surg Br. 2010 Feb;92(2):273-6.

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