Genu Varum or Bowlegs: Causes and Treatment

Genu varum or bowlegs is a condition that affects the natural or anatomical alignment of the knees. Children who suffer from it have an exaggerated curvature that separates their knees and brings their ankles and feet closer together.
Genu Varum or Bowlegs: Causes and Treatment
Galo Flores

Written and verified by the doctor Galo Flores.

Last update: 10 October, 2022

Bowlegs is a condition that affects the natural or anatomical alignment of the knees. Children who suffer from it have an exaggerated curvature that separates their knees and brings their ankles and feet closer together. Its technical name is genu varum.

This word comes from the Latin genu which means “knee” and varum which means “moves away from the midline of the body”.

This condition is normal in babies up to one and a half years of age. The legs begin to straighten from 12 months of age or when they begin to walk.

If their legs don’t straighten when they’re between two and three years of age or if they bow more, you need to consult your child’s pediatrician. Below, we’ll explain how they assess a child with genu varum.

Does genu varum cause any other symptoms?

Bow-legged children sometimes walk with their toes pointed inward. Experts call this intoeing or pigeon-toes and it can make them trip a lot.

This problem usually resolves without on its own as children get older. However, when bowlegs continue into adolescence, they can cause ankle, knee, or hip pain.

The main causes of genu varum or bowlegs

Babies are born with bowlegs due to their position in the womb. Some of the bones rotate a bit as they grew inside their mother’s womb to fit into the small space.

This curvature is called physiologic bowlegs. Doctors consider it a normal stage of a child’s growth and development.

In some children, this condition can also be caused by bone fractures that didn’t heal properly.

Different types of legs.
Each person’s lower limbs are different, and their knees could be closer to or farther away from the midline.

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Diagnosis of genu varum

To determine if a child suffers from genu varum, the doctor will assess their medical history. Doctors usually do tests on children over two years of age.

They usually follow these steps during a physical exam:

  1. Measure the distance between both knees with the child lying on their back.
  2. Observe how the child walks to determine an abnormal gait.

If there’s no discomfort and their legs are almost symmetrically bowed, the doctor will only recommend observation. In other words, the parents must keep a close eye on their child’s development to see if the bowing improves with time.

Only some cases will require an orthopedic assessment. The professional will determine if:

  • The legs aren’t straightening on their own.
  • If the bowing is asymmetric (the legs are bowed to different degrees).
  • The child has other symptoms such as pain, limping, weakness, or trouble walking and running.

If this is the case, the doctor will order an X-ray if they suspect Blount’s disease. This disorder is when the shin bone (tibia) is turned inward. It’s a growth disorder that slowly worsens over time. Experts don’t yet understand its cause.

Another cause of genu varum is rickets. A vitamin D deficiency causes this disorder. To detect it, the orthopedist will order blood tests.

Treatment for genu varum or bowlegs

If the doctor determined that the bowing is physiological, they won’t indicate any type of treatment. The legs will correct themselves as the child grows. Experts recommend taking children to see their doctors every six months to see if their legs are improving.

There are two types of treatment to correct them. One is orthopedic appliances and the other is surgery.

Non-surgical treatment

Some children may require orthopedic appliances or braces. They’re used in severe cases of bowlegs or in cases of Blount’s disease.

Doctors usually indicate vitamin D to patients with rickets and also recommend incorporating more calcium in their diet. Similarly, they recommend increasing their exposure to sunlight.

Surgical treatment

The orthopedist can determine if the degree of bowing requires surgery. Cases of Blount’s disease are likely to require surgical treatment.

The doctors can do the surgery at an early age. In special cases, it can be done once the child has stopped growing. The decision will depend on the severity of the bowing and the benefits.

A child with a doctor.
The treatment of this condition will depend on its severity and on whether the doctor suspects an underlying condition or physiological process.

Recovery and prognosis

Since it can simply be part of development, there are no preventive measures for bowlegs. As we explained above, in many children, it’s only another stage of growth.

One of the causes that can be prevented is rickets. To avoid this condition, children should play outdoors to get sunlight.

Cases of physiologic bowlegs have a good prognosis. In most cases, the bowing will correct itself and the child won’t have trouble walking.

When severe bowing isn’t treated, it can lead to osteoarthritis of the knees or hips in adult life.

Genu varum isn’t always physiological

Children with physiologic bowlegs don’t need to make changes in their daily activities. They can walk, run, and play normally. In fact, they can be active like all other children their age.

Parents simply have to keep a close eye on their growth and development. Consult your doctor if your child’s legs don’t straighten on their own or additional discomfort appears.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

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  • Macedonio Barral ZJ, Cruz Pérez EF, Iriarte Vincenti S, Arias C. Análisis de las deformaciones de la tibia humana a consecuencia del genu varum. Cuadernos Hospital de Clínicas. 2014;55(4):69-75.
  • Jalil A, Ferreyra C, Balla M. Genu varo artrósico inestable: seguimiento a 2 años. Rev. Asoc. Argent. Traumatol. Deporte. 2017:20-4.
  • Morgado I, Pérez AC, Moguel M, Pérez-Bustamante FJ, Torres LM. Guide for the clinical management of osteoarthritis of the hip and the knee. Rev Soc Esp Dolor 2005; 12: 289-302.
  • Domínguez Gasca, Luis Gerardo, Germán Navarro Vidaurri, and Luis Gerardo Domínguez Carrillo. “Tibias varas: enfermedad de Blount.” Atención Familiar 25.2: 86-87.

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.