Genu Varum (Bow legs)
Physiological bowing is the most common cause of genu varum. It is a normal variant and usually corrects by the age of 2-3. It can be associated with overweight babies/toddlers as well as early walkers and can also be associated with in-toeing gait.
Be aware of pathological causes e.g. Rickets and Blount’s disease, indicated by swellings at the wrist and ankles, a poor dietary history and marked, progressive or asymmetrical bowing.
Action: Key assessment points
- Observe the child in supine, standing and observe gait
- Check for symmetry and leg length discrepancy
Action: Referral not indicated
- Symmetrical asymptomatic genu varum
- Reassure parents. Physiological bow legs will begin to resolve by age 2 with normal development. No specific treatment is required
- Consider completing bloods for Vitamin D and recommend supplements if indicated
- Reassure the parent/guardian and if indicated give advice leaflet titled bow legs and knock knees in children
- Provide information on healthy weight management
Action: Refer to Paediatric Physiotherapy
- There is associated muscle tightness and/or weakness with associated pain
Action: Refer to Paediatric Orthopaedics
- Significant genu varum present after 2 years or progressively worsens from 12-18 months (Rickets and Blount's need to be excluded)
- Asymmetrical knee Varus
- Inter-condylar distance with feet together over 6cm in standing
Action: Refer to Podiatry or Orthotics
- Flat feet/calcaneo-valgus foot posture is causing pain, rubbing or uneven shoe wear
