Bow Knees – Everything you need to know

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Bow Knees

Bow knees is a condition in which the legs look bowed out, meaning the knees remain wide apart even when the ankles are together. Bow knees are also called congenital genu varum.

The condition is mostly found in infants due to their cramped position in the womb. However, no treatment is required for infants. Their legs will start to straighten when they begin walking, often between 12 and 18 months of age.

However, one must visit an orthopedic doctor in Gurgaon if the child continues to have bow knees after the age of 2. In several cases, no lasting side effects are visible.

Continue reading to learn more about the causes, symptoms, treatment and prevention of bow knees.

Causes of bow knees

1. Physiologic genu varum

In many children under two years old, bow knees are typically a normal variation in leg appearance. Specialists refer to this bowing form as physiologic genu varum.

In children with physiologic genu varum, the bowing starts to improve after 18 months of age slowly and improves as the child grows. By ages 3 to 4years, the bowing is gone, and the legs have a normal look.

2. Blount’s disease

In Blount’s disease, which is also known as tibia vara, the child’s shin builds abnormally, curving below their knees. As the child begins walking, the bow knees get worse.

This condition may be noticeable early on, yet in a few cases, signs may not be apparent till the child reaches adolescence. As time passes, bow knees can progress to joint issues in their knees.

Blount’s disease is found more in females and children with obesity. Children who start walking early are at a higher risk. The child should normally begin walking on their own between 11 and 14 months of age.

3. Rickets

Rickets is a condition resulting from a lack of vitamin D which weakens and softens the bones, making the knees bow.

4. Paget’s disease

Metabolic disease negatively affects the way the bones break down and regenerate. In Paget’s disease, the bones do not regenerate as strongly as they should. As time passes, this can progress to bow knees and other joint issues.

Paget’s disease is found more in aged individuals and can be successfully controlled with early diagnosis and treatment.

5. Dwarfism

A condition called achondroplasia causes the most common type of dwarfism. It is a bone development disorder that can cause bow knees as time passes.

6. Other causes

Bow knees can also be an outcome of:

  • Bone fractures that have not healed correctly
  • Unnaturally growing bones, or bone dysplasia

Recognizing the symptoms of bow knees

Recognizing the symptoms of bow knees

It is a noticeable condition. The knees will not touch when one stands with their ankles and feet together. Bow knees appear symmetrical.

Several bow knees cases begin to improve when the child is 12 to 18 months old. The parents should consult a paediatric orthopaedic if the child’s legs are bowed even after the age of 2 or if their condition worsens.

Diagnosing bow knees

Bow knees are simple to identify. However, the specialist can tell a person how serious the condition is or if an underlying disease causes it.

When one visits their orthopaedic doctor, the doctor will likely take their leg measurements and see how they walk.

They might do an X-ray or other imaging tests to check for any bone abnormalities in the knees and legs. 

The orthopaedist might perform blood tests to find whether any other condition has caused the bow knees, like Paget’s disease or rickets.

Treatment for bow knees

Nonsurgical treatment

  • Physiologic genu varum

Physiologic genu varum does not require active treatment. However, the doctor will check the child every 6 months until the bowing has resolved.

  • Blount’s disease

Infantile Blount’s disease does need treatment for the bowing to improve. If the disease is determined early, treatment using a brace may be all that is required. Bracing is not beneficial for adolescents having Blount’s disease.

  • Rickets

If the child has rickets, the specialist will refer the parents to a metabolic doctor for medical management and normal orthopaedic follow-up. The effects of rickets can usually be controlled with medicines.

Surgical treatment

  • Physiologic genu varum

In some cases, the child’s physiologic genu varum will not completely resolve. Also, in adolescence, the bowing may cause the family and the child to have cosmetic concerns. If the deformity is severe, then treatment can be used to fix the remaining bowing. A guided growth surgery may be required.

  • Blount’s disease

If the child continues to have infantile Blount’s disease despite the brace’s use, treatment at the age of 4 will be required. Treatment may prevent more worsening and stop permanent damage to the growth plate of the shinbone.

Older children with bowed knees because of adolescent Blount’s disease need surgery to fix the issue.

  • Rickets

Treatments may also be required for children with rickets whose deformities continue despite management with medicines.

Surgical procedures

There are various surgical procedures to fix bowed knees, and they come under two main forms.

  • Guided growth

Guided growth is the most found form of surgery done for this condition. The orthopaedic surgeon will use a small staple or metal plate to prevent growth on the shinbones’ healthy side temporarily. It provides the abnormal side an opportunity to catch up, straightening the leg with the child’s natural development. Once the alignment is improved, the staple or plate is taken out, and growth resumes.

  • Tibial osteotomy

In this treatment, the shinbone is cut below the knee and reshaped to fix the alignment. The bone is kept in place while it heals with either screw and an internal plate or an external frame placed outside the leg.

After the procedure, a cast may be applied in some cases to safeguard the bone while it heals. Crutches may be required for some weeks, and the specialist may suggest physical therapy exercises to regain strength and range of motion. 

Can bow knees be prevented?

There is no found prevention for bow knees. In some cases, the conditions that cause bow knees can be prevented.

For instance, one can stop rickets by ensuring their child gets sufficient vitamin D through diet and sunlight exposure. 

Early diagnosis and treatment can help to control the bow knees condition in children.

Dr. Ratnav Ratan
Dr. Ratnav Ratan
Pediatric Orthopedist and Sports Medicine specialist​

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