Meaning
A physical condition known as genu varum is characterized by an outward bowing of the leg about the thigh, resembling the bow of an archer. Usually, both the femur’s and the tibia’s medial angulations are implicated.
Toddlers with bowed legs are quite prevalent. When a youngster stands with his or her feet together and has bowed legs, there is a clear space between the lower legs and knees. It could be because one or both of the legs have an outward curvature.
Causes
- Physiologic genu varum: In most children under 2 years old, bowing of the legs is simply a normal variation in leg appearance. In children with physiologic genu varum, the bowing begins to slowly improve at approx. 18 months of age and continues as the child grows. By ages of 3 to 4, the bowing has corrected and legs typically have a normal appearance.
- Blount’s disease: Blount’s disease is a condition that can occur in toddlers as well as in adolescents. It results from an abnormality of the growth plate in the upper part of the tibia. In a child under the age of 3 years, the bowing will worsen and obvious problems can be seen in an x-ray.
- Rickets: a rare condition where a lack of vitamin D results in bone diseases as it is essential for the process of bone calcification. Children with rickets do not get enough calcium, phosphorous, or vitamin D all of which are important for healthy growing bones.
- Early weight bearing especially in children who are fat and heavy.
- Osteomalacia: rickets in adult is called osteomalacia. The bone becomes soft and weak, which can lead to fractures in adults. Poor calcification stems from a lack or impaired metabolism of vitamin D.
- Achondroplasia: a disorder characterized by problems with bone growth. There is marked shortness of the long bone due to a defect in growth leading to dwarfing. There is the failure of normal calcification.
- Osteoarthritis: degenerative bone disease. Progressive diseases affect the joints of the body as the cartilage of joints breaks down over time.
- Trauma or injury around the knee joint.
- Infection of bones.
- Malnutrition: kwashiorkor, a malnutrition state that is produced by severe protein deficiency.
- Congenital
Symptoms
- Bowed legs are most evident when a child stands and walks.
- The most common symptom of a bowed leg is an awkward walking pattern.
- Bowed legs do not typically cause any pain.
- During adolescence, persistent bowing can lead to discomfort in the hips, knees, and ankles because of the abnormal stress that the curved legs have on these joints.
Changes occur
- Ligaments on the lateral aspect of the knee are lengthened, whereas the ligaments of the medial side are shortened.
- Ligamentous instability may be present.
- Muscles of the lateral aspect elongate whereas muscles of the medial aspect get contracted.
- The shaft of the tibia and fibula are bent with convexity on the lateral aspect. Similarly, deformity is seen in the shaft of the femur.
- Postural defect with internal rotation of the hip and hyperextension in the knee. An awkward gait pattern called a waddling gait is seen (walking like a duck).
Examination
- Degree of deformity is specifically measured.
- Knee motion and ligamentous instability are assessed.
- X-ray is used to confirm knee exceeds more than 8 cm or if it’s unilateral it should be investigated.
Treatment
- Generally, no treatment is required for idiopathic presentation as it is a normal anatomical variant in growing children.
- Treatment is indicated when it persists beyond 8 and half years old, unilateral presentation, or is progressive or worsening of the curvature.
- During childhood, ensure the proper intake of vitamin D to prevent rickets, at the same time instructing the mother never to place the child on its feet.
- 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.
- Treatment should be done to relieve pain, strain, or ankle muscle spasms if any.
- Stretching exercises for quadriceps, hamstring, and gluteus muscles are given.