What is the recommended treatment for a 15-month-old child with genu varum (bowleggedness)?

Management of Genu Varum in a 15-Month-Old Child

For a 15-month-old child with genu varum (bowleggedness), observation without intervention is the recommended approach as this is likely physiologic bowing that will resolve spontaneously with growth.

Understanding Physiologic Genu Varum

• Physiologic genu varum is a common finding in early childhood that typically does not require treatment and has a favorable natural history 1
• The condition is most prevalent in children under 2 years of age and typically resolves spontaneously by 5-7 years of age 2
• Physiologic bowing must be distinguished from pathologic causes such as Blount's disease, rickets, or metabolic bone disorders 3

Assessment Approach

• Measure intercondylar distance to quantify the severity of the varus deformity 4
• Evaluate for signs of underlying conditions such as short stature, growth impairment, or other skeletal abnormalities 4
• Consider vitamin D status, as recent research suggests that even "physiologic" genu varum may be associated with vitamin D insufficiency/deficiency 5
• Standing radiographs are not routinely needed for typical physiologic bowing but may be indicated if:
  • The deformity is severe or asymmetric
  • The child is older than expected for physiologic bowing
  • There are concerns for underlying pathology 1

Management Recommendations

For Typical Physiologic Genu Varum

• Observation with regular monitoring of the deformity every 3-6 months 4
• No bracing, orthotics, or surgical intervention is indicated 2
• Reassurance to parents that spontaneous resolution is expected 3

Nutritional Considerations

• Ensure adequate vitamin D and calcium intake, as deficiencies have been associated with persistent genu varum 6
• Consider vitamin D supplementation if dietary intake is insufficient, especially during winter months 6
• Ensure adequate dairy product consumption or appropriate alternatives for calcium 6

When to Consider Further Evaluation

• If the deformity is progressive rather than improving 4
• If the child demonstrates short stature or growth impairment 4
• If there are signs of metabolic bone disease (elevated alkaline phosphatase, abnormal calcium/phosphate levels) 5
• If the deformity persists beyond 3-4 years of age 2

Follow-up Recommendations

• Regular clinical assessment every 3-6 months to monitor progression or resolution 4
• Measure intercondylar distance at each visit to document improvement 4
• Consider laboratory evaluation (vitamin D, calcium, phosphate, alkaline phosphatase) if the deformity persists or worsens 5

Important Considerations

• Physiologic genu varum should not be confused with pathologic conditions like X-linked hypophosphatemia, which presents with similar but more severe and persistent bowing 4
• Recent research challenges the concept that all physiologic genu varum is truly "physiologic," suggesting that some cases may be related to subclinical vitamin D disorders even without radiographic evidence of rickets 5
• Long-term studies suggest that approximately one-third of individuals with childhood physiologic genu varum may experience mild pain or stiffness in adulthood, though the clinical significance remains unclear 2