Bowlegs (Genu Varum): Understanding Causes, Natural Resolution, and Treatment Options

Do Bowlegs go away?

Physiological bowlegs, common in infants and toddlers, typically resolve naturally as a child grows, often by age two or three. However, bowlegs caused by underlying medical conditions or those that persist into later childhood or adulthood are generally structural deformities that will not go away on their own and may require medical intervention.

Understanding Bowlegs (Genu Varum)

Bowlegs, medically known as genu varum, is a condition characterized by an outward bowing of the legs, causing the knees to remain wide apart when the ankles are brought together. This alignment issue affects the lower limbs, specifically the angle between the femur (thigh bone) and the tibia (shin bone), leading to an appearance where the legs resemble an archer's bow. While a certain degree of bowing is normal at various stages of development, particularly in infancy, persistent or progressive genu varum can indicate an underlying issue.

Causes of Bowlegs

The etiology of bowlegs varies significantly with age and can be broadly categorized into physiological and pathological causes. Understanding the root cause is crucial for determining the likelihood of resolution and appropriate management.

• Physiological Bowlegs: This is the most common form, observed in infants and toddlers. It's considered a normal part of development, often attributed to the cramped position in the womb. Babies are born with a degree of bowing that gradually corrects as they begin to bear weight, walk, and develop muscle strength. This type usually improves spontaneously.
• Pathological Bowlegs: These are less common and indicate an underlying medical condition. They typically do not resolve on their own and may worsen over time. Causes include:
  • Rickets: A bone-softening disease primarily caused by prolonged vitamin D deficiency, leading to impaired bone mineralization and abnormal bone growth. Nutritional rickets is the most common form, but genetic forms also exist.
  • Blount's Disease (Tibia Vara): A growth disorder affecting the growth plate near the top of the shin bone (tibia), causing the bone to curve outward just below the knee. It can affect one or both legs and may appear in early childhood (infantile Blount's) or adolescence (adolescent Blount's).
  • Fractures or Trauma: Poor healing of a fracture in the growth plate area of the tibia or femur can lead to angular deformities.
  • Skeletal Dysplasias: Rare genetic conditions that affect bone and cartilage growth, leading to various skeletal abnormalities, including bowlegs.
  • Osteoarthritis: Particularly in older adults, severe, unilateral knee osteoarthritis can lead to cartilage loss and bone erosion predominantly on the inside (medial) compartment of the knee, resulting in a varus deformity.
  • Paget's Disease of Bone: A chronic disorder that results in enlarged and misshapen bones due to abnormal bone remodeling.
  • Fluorosis: Excessive fluoride intake can lead to skeletal abnormalities.

Do Bowlegs Go Away? Natural Progression vs. Persistent Cases

The answer to whether bowlegs go away hinges entirely on the underlying cause:

• Resolution of Physiological Bowlegs: For the vast majority of infants with physiological bowlegs, the condition resolves spontaneously. The legs typically straighten out between the ages of 18 months and 3 years as the child's muscular development and weight-bearing activities promote natural alignment. By school age, most children have straight legs or even a slight degree of knock-knees (genu valgum), which also often corrects itself.
• Persistence of Pathological Bowlegs: In contrast, bowlegs caused by conditions like rickets, Blount's disease, or other skeletal disorders will not resolve on their own. Without appropriate medical intervention, these conditions can worsen, leading to increased deformity, pain, gait abnormalities, and premature degenerative joint disease (osteoarthritis) in adulthood.

Diagnosis and Assessment

A comprehensive diagnosis of bowlegs involves a detailed medical history, physical examination, and often imaging studies.

• Clinical Examination: A healthcare professional will assess the child's gait, leg alignment, and range of motion. Measurements may be taken to quantify the degree of bowing and monitor progression.
• Radiographs (X-rays): Weight-bearing X-rays of the lower limbs are crucial. They allow for precise measurement of angles (e.g., femorotibial angle), assessment of growth plates, and identification of underlying bone abnormalities like those seen in rickets or Blount's disease.
• Blood Tests: If rickets is suspected, blood tests to check vitamin D, calcium, and phosphate levels may be ordered.

Treatment and Management Strategies

Treatment approaches for bowlegs depend on the cause, severity, and the patient's age.

• Observation: For physiological bowlegs in infants, observation is the primary approach. Regular follow-up appointments are scheduled to monitor the natural progression and ensure the bowing resolves as expected.
• Bracing: In some cases of progressive Blount's disease in young children, orthotic bracing may be used to guide bone growth and correct the deformity. The effectiveness of bracing is highly dependent on the child's age, the severity of the condition, and consistent use.
• Nutritional Intervention: For rickets caused by vitamin D deficiency, treatment involves vitamin D and calcium supplementation, along with dietary modifications. This can lead to significant improvement and even resolution of the bowing in many cases, especially if caught early.
• Surgical Intervention (Osteotomy): For severe, persistent, or progressive bowlegs that do not respond to conservative measures, or for cases like advanced Blount's disease or significant osteoarthritis, surgical correction (osteotomy) may be necessary. An osteotomy involves cutting and reshaping the bone (usually the tibia or femur) to correct the alignment, often using plates, screws, or external fixators to hold the bone in the new position while it heals.

The Role of Exercise and Kinesiology

It is crucial to understand that exercise and kinesiology cannot correct a fixed structural bone deformity like pathological bowlegs. The shape of the bones determines the alignment, and exercise cannot reshape bone.

However, exercise plays a vital supportive role in:

• Optimizing Joint Mechanics: While not correcting the underlying bone angle, targeted exercises can help improve the mechanics of the knee, hip, and ankle joints.
• Addressing Muscle Imbalances: Bowlegs can lead to compensatory muscle imbalances. For example, muscles on the outside of the thigh may become overactive, while those on the inside may be underactive. Kinesiology interventions can focus on strengthening weak muscles (e.g., hip abductors, gluteus medius, VMO) and stretching tight ones to improve overall lower limb function and reduce undue stress on the knee joint.
• Improving Gait and Posture: Exercise can help improve walking patterns, balance, and overall posture, which may be altered by significant bowing.
• Pain Management: Strengthening surrounding musculature and improving joint stability can help alleviate pain associated with altered biomechanics.
• Pre- and Post-Surgical Rehabilitation: For individuals undergoing corrective surgery, exercise is indispensable for preparing the body for the procedure and for rehabilitation afterward to restore strength, range of motion, and function.
• Maintaining Overall Lower Limb Health: Regular, appropriate exercise can contribute to stronger bones and muscles, which is beneficial regardless of the presence of bowlegs.

When to Seek Professional Advice

While physiological bowlegs typically resolve, it's important to consult a healthcare professional, especially a pediatrician or orthopedic specialist, if:

• The bowing is severe or appears to be worsening.
• The bowing is asymmetrical (only one leg is affected).
• The child experiences pain, limping, or difficulty walking.
• The bowing persists beyond the age of 2-3 years.
• There are other associated symptoms, such as short stature or other skeletal abnormalities.
• An adult develops bowlegs or experiences increasing pain and functional limitations due to existing bowing.

Conclusion

The question of whether bowlegs go away depends on their origin. Physiological bowlegs in infants are a normal developmental phase that nearly always resolves spontaneously. In contrast, pathological bowlegs, stemming from conditions like rickets or Blount's disease, are structural deformities that will not correct on their own and require medical diagnosis and intervention. While exercise and kinesiology cannot alter bone shape, they are invaluable for optimizing surrounding muscle function, improving gait, managing symptoms, and supporting individuals through surgical rehabilitation. Early diagnosis and appropriate management are key to ensuring the best possible outcomes for individuals with bowlegs.