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Genu Varum (Bowed Legs)

Overview

Genu varum, commonly known as bowed legs, is a paediatric orthopaedic condition where the legs curve outwards at the knees while the ankles remain close together. It can be part of normal growth in young children but may also indicate an underlying bone or growth disorder if it persists. 

Genu varum can be categorised into the following types:

  • Physiological genu varum is the natural bowing seen in children under 2 years of age, which usually corrects itself as the child grows.
  • Pathological genu varum occurs due to underlying conditions such as rickets, Blount disease, or genetic bone disorders, and often requires treatment.

Children with genu varum may show:

  • No symptom apart from cosmetic concerns.
  • Difficulty in walking or pain on the outer side of the knees in some cases.

Common causes and contributing factors include:

  • Bowing of the knees is normal till the age of 2 years.
  • Vitamin D deficiency.
  • Bone growth disorders like rickets, Blount disease, and osteogenesis imperfecta.
  • Genetic disorders, such as Carpenter syndrome.

Doctors use several tests to diagnose genu varum:

  • Physical examination: The child stands with both ankles together and the distance between the  knees and ankles is measured.
  • A full-length radiograph (X-ray) of the legs (scanogram): This helps measure the degree of bowing.
  • X-ray of the knee joints in two positions (anteroposterior and lateral views): This helps examine the growth plates.
  • Computed tomography (CT): This helps plan treatments.
     

Based on the severity of the condition, genu varum may be treated using one or more of the following approaches: 

  • Non-surgical approaches: Non-surgical treatment is the primary line of management. It includes:
    • Observation for physiological (natural) bowing, as it usually corrects naturally.
    • Nutritional supplements and dietary corrections in case of vitamin D deficiency.
    • Bracing to correct mild deformity.
  • Surgical approaches: Surgery is considered when deformity is severe or does not improve with conservative treatment. Options include:
    • Corrective osteotomy, where the bone is cut and realigned. Small plates or screws may be placed to restrict the growth on the outer side of the knees, allowing gradual correction.
    • The implants are usually removed once the child achieves complete growth. However, growth may be restricted when the screw penetrates the growing region of the bone.

Parents should seek medical advice if:

  • The bowing persists beyond 2–3 years of age.
  • The deformity worsens with growth.
  • The child develops pain, limping, or difficulty in walking.

Some cases of genu varum cannot be prevented, especially when linked to genetics. However:

  • Ensuring adequate vitamin D intake during pregnancy and childhood helps prevent rickets.
  • Encouraging outdoor play and sunlight exposure supports bone health.

If a child has bowed legs, the appropriate specialist to consult is a paediatric orthopaedic surgeon. A paediatrician may also be involved in identifying underlying causes such as nutritional deficiencies.

Disclaimer:

The information in this Health Library is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional with any questions about a medical condition or before starting any treatment. Use of this site and its content does not establish a doctor–patient relationship. In case of a medical emergency, call your local emergency number or visit the nearest emergency facility immediately.