Genu Varum
Genu Varum is also known as Bow Leg. It is a deformity
wherein there is lateral bowing of the legs at the knee. This is usually due to defective growth of the medial side of
the epiphyseal plate. It is commonly seen unilaterally and seen in conditions
such as Rickets, Paget's
disease and severe degree osteoarthritis of the knee. The degree of deformity is measured by the distance between the two medial
femoral condyles when the patient is lying.
Treatment of Bow legs
Generally, no treatment is required for idiopathic
presentation as it is a normal anatomical variant in young
children. Treatment is indicated when its persists beyond 3 and half
years old, Unilateral presentation, or progressive worsening of the curvature.
During childhood, assure the proper intake of vitamin
D to
prevent rickets.
Mild degree of deformity can be treated by wearing surgical
shoes with 3/8" outer raised and with a long inner rod extending to the
groin and leather straps across the tibia and the knee. Corrective operations
can also be performed, if necessary. The person would need to wear casts or
braces following the operation.
Post operative
Physiotherapy
- Gradual knee
mobilization is the main
part of the treatment.
- Some heat
modalities may be given
for relief of pain.
- Strengthening exercises for quadriceps,
hamstrings and gluteus muscles are given.
- When the patient is able to walk, he is given
correct training for standing, balancing,
weight transferring and walking.
PATHOLOGIC GENU VARUM
Tibia
Vara (Blount Disease)
Idiopathic tibia vara, or Blount disease, is the most
common pathologic disorder producing a progressive genu varum deformity. It is
characterized by abnormal growth of the medial aspect of the proximal tibial
epiphysis, resulting in a progressive varus angulation below the knee. Tibia
vara can occur at any age in a growing child.
It is classified according to the age at clinical onset, as follows: infantile
(1 to 3 years), juvenile (4 to 10 years), and adolescent (≥11 years). The
infantile group is the most common; the juvenile and adolescent forms typically
are combined as late-onset tibia vara, which occurs much less frequently.
Etiology Although the exact cause of tibia vara is unknown, it seems to be
secondary to growth suppression from increased compressive forces across the
medial aspect of the knee.
Clinical Manifestations
The characteristics of infantile tibia vara include
predominance of black race, female gender,
marked obesity,
approximately 80% bilateral involvement, a prominent medial metaphyseal beak,
internal tibial
torsion, and lower extremity length inequality. Characteristics of
the juvenile and adolescent (late-onset) form are black race, predominance of
males, marked obesity, approximately 50% bilateral involvement, slow
progressive genu
varum deformity,
pain rather than deformity as the primary initial complaint, no palpable
proximal medial metaphyseal beak, minimal internal tibial torsion, mild medial
collateral ligament laxity, and mild lower extremity length inequality. The
differences between the three tibia vara groups seem to be related primarily to
the age at clinical onset, the amount of remaining growth, and the magnitude of
the medial compression forces on the involved side. The infantile-onset group
has the potential for the greatest deformity, and the adolescent-onset group
has the least.
Diagnosis
Radiographic Evaluation Standing anteroposterior and lateral
radiographs of the lower extremities are necessary to assess pathologic genu
varum deformities. Radiographically, fragmentation with a protuberant step
deformity and beaking of the proximal medial tibial metaphysis are considered
the major features of infantile tibia vara. The changes of the proximal medial
tibia are less conspicuous in the late-onset forms and are characterized by
wedging of the medial portion of the epiphysis, a mild posteromedial articular
depression, a serpiginous cephalad curved physis of variable width, and mild or
no fragmentation or beaking of the proximal medial metaphysis. The major
deformity that must be differentiated from infantile tibia vara is the
physiologic genu varum deformity. It is difficult to differentiate
radiographically between these two disorders in children younger than 2 years
old.
Treatment
When the radiographic findings confirm the diagnosis,
treatment should begin immediately. Orthotic management may be considered for
children 3 years or younger with a mild deformity. Approximately 50% of
children with this criterion may achieve adequate correction using orthoses.
Conservative management in the late-onset forms of tibia vara is
contraindicated. The children are too large, compliance is poor, and the
remaining growth is too small to allow for adequate correction. The indications
for surgical treatment in infantile tibia vara include 4 years of age or older,
failure of orthotic management, and moderate to severe deformity. Proximal
tibial valgus osteotomy with associated fibular diaphyseal osteotomy is the
procedure of choice.
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