Genu varum

Alternative names 
Bowlegs

Definition
Bowlegs is a condition observed when a person stands with the feet and ankles together, but the knees remain widely apart.

Causes, incidence, and risk factors

Infants are born bowlegged because of their folded position in the uterus. The infant’s bowed legs begin to straighten once the child starts to walk and the legs begin to bear weight (about 12 to 18 months old).

Normal appearance is usually attained by the time the child is three years old. At this time, a child can usually stand with the ankles together and the knees just touch. If the bowed legs persist into this period, the child is called bowlegged.

Severely bowed legs can be a sign of rickets. Rickets is caused by a vitamin D deficiency, and in the United States breast-fed infants with dark skin are most at risk. Other causes of bowleggedness include Blount’s disease, bone dysplasias, and lead or fluoride intoxication.

Symptoms

     
  • Knees do not touch when individual stands with feet together (ankles touching)  
  • Symmetrical bowing of legs  
  • Persistence of bowed legs beyond three years of age

Signs and tests

Physical examination of the child is usually sufficient to make this diagnosis. Blood tests may be needed to rule out rickets.

X-rays may be necessary if the child is three years old or older, if the bowing is getting worse, if it is asymmetric, or if other findings suggest disease.

Treatment

No treatment is recommended for bowlegs unless the condition is extreme. The child should be reassessed at least every 6 months.

If the condition is severe, special shoes can be worn that rotate the feet outward with an 8 to 10 inch bar between them, although it is unclear how well these work. Occasionally, in an adolescent with severe bowlegs, surgery is performed to correct the deformity.

Expectations (prognosis)
In many cases the outcome is good, and there is usually no problem walking.

Complications
There are usually no complications.

Calling your health care provider
Call your health care provider if your child shows persistent or worsening bowed legs after three years old.

Prevention
There is no known prevention other than that to avoid rickets. Make sure your child has normal exposure to sunlight and appropriate levels of vitamin D in the diet.

Johns Hopkins patient information

Last revised: December 7, 2012
by Sharon M. Smith, M.D.

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