From the Guidelines
The treatment for physiologic genu varum (bowleggedness) in children is typically observation and reassurance, as this condition usually resolves spontaneously without intervention. Parents should be educated that physiologic bowing is a normal developmental variant affecting many children under age 2, with most cases correcting naturally by age 3-4 years. No braces, special shoes, or exercises are needed for physiologic genu varum. Regular monitoring by a pediatrician during well-child visits is sufficient to ensure the condition is improving over time. Medical intervention is only warranted if the bowing is severe, asymmetric, progressive after age 2, associated with short stature, or accompanied by pain or limping, as these features suggest pathologic causes rather than physiologic bowing.
In cases where surgical intervention is necessary, guided growth surgery has emerged as a less invasive technique, particularly for valgus or varus deformities, as noted in the management of X-linked hypophosphataemia 1. This approach involves placing a small metal plate on the medial or lateral surface of the bone at the level of the physis, allowing for differential growth and improvement in alignment over time. However, this is not typically recommended for physiologic genu varum unless it persists or is severe. The natural resolution of physiologic genu varum occurs because as children grow and develop a more mature gait pattern, their lower limb alignment gradually shifts from varus (bowlegged) to neutral and sometimes to mild valgus (knock-kneed) alignment, following a predictable developmental pattern.
Key points to consider in the management of physiologic genu varum include:
- Observation and reassurance as the primary approach
- Education of parents on the natural history of the condition
- Regular monitoring for spontaneous resolution
- Consideration of guided growth surgery or other interventions only in cases of severe, persistent, or pathologic deformity, as informed by the latest clinical practice recommendations 1.
From the Research
Treatment for Physiologic Genu Varum
The treatment for physiologic genu varum, also known as bowleggedness, in children is primarily focused on monitoring the progression or resolution of the varus deformity.
- Most cases of physiologic genu varum do not require any treatment, as the condition typically resolves on its own as the child grows 2, 3, 4, 5.
- Primary care physicians can manage most children presenting with bow legs by following a protocol that includes regular follow-up and a simple clinical assessment to monitor varus progression and screen for pathologic bowing 3.
- The use of standing radiographs of the entire lower limbs is necessary for surgical planning in cases where intervention is required, as the deformity can sometimes affect the distal femur rather than the proximal tibia 2.
- Guided growth is a treatment option for genu varum, but the rate of angular correction can be unpredictable and may be affected by various factors, including non-idiopathic coronal deformity of the knee and obesity 6.
Key Considerations
- Physiologic genu varum is a normal condition in early childhood that does not require any treatment in most cases 4, 5.
- The condition can be distinguished from other conditions, such as Blount's disease, prenatal genu varum, hypophosphataemia, rachitis, and post-traumatic genu varum, based on its course, roentgenological picture, and laboratory examination 5.
- Long-term follow-up is necessary to monitor the progression or resolution of the varus deformity and to identify any potential complications, such as mild pain or stiffness, especially on exertion 4.