Peds

Genu Varum

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Genu Varum, Bowed legs

  • Pathophysiology
  1. Normal finding in the newborn
  2. Physiologic bowing of the lower extremities
    1. External rotation of femur
    2. Internal rotation of tibia
  • Symptoms
  1. Noted first at walking age
  • Signs
  1. Knees bow apart
  2. Typically symmetric and bilateral
  3. Measuring degree of Genu Varum
    1. Child stands with medial malleoli touching
    2. Measure distance between medial femoral condyles
  • Differential Diagnosis
  1. Rickets
  2. Skeletal dysplasia
  3. Blount's disease
    1. Obesity-related abnormal growth of medial proximal tibial physis
  4. Tibial Bowing
    1. Anterolateral bowing
      1. Neurofibromatosis association
    2. Posteromedial bowing
      1. In utero calcaneovalgus foot (will correct)
  5. High impact sports
    1. May generate Genu Varum in teens
  • Management
  1. No management (bracing, connective bars, Orthotics) needed in most cases
  2. Surgical osteotomy may be considered in severe, non-resolving cases
  • Course
  1. Persistence after age 2 years is atypical
  2. Often transitions to Genu Valgum (Knock-Knees)
    1. Occurs between ages 18 months to 3 years
    2. Corrects spontaneously by ages 6 to 10 years
  • Complications
  1. Premature Osteoarthritis
  • References
  1. Rerucha (2017) Am Fam Physician 96(4): 226-33 [PubMed]