Varus: Understanding Inward Anatomical Alignment and Deformities

What position is varus?

Varus refers to an anatomical alignment in which a distal segment of a bone or joint deviates medially (inward) relative to its proximal segment, often resulting in a bow-legged appearance or inward angulation.

Understanding Anatomical Terminology

In exercise science, kinesiology, and medicine, precise anatomical terminology is crucial for describing body positions, movements, and structural deviations. Terms like "varus" and "valgus" are used to describe angular deformities, particularly at joints, indicating the direction of the deviation of the distal segment relative to the proximal segment. Understanding these terms is fundamental for assessing posture, analyzing gait, and prescribing appropriate exercise or rehabilitation strategies.

Defining Varus

The term "varus" describes a condition where the segment of a limb distal (further away from the trunk) to a joint is angled inward (medially) toward the midline of the body, relative to the segment proximal (closer to the trunk) to that joint. This creates an angle that points away from the midline.

To illustrate:

• Imagine a straight line running through the center of the proximal bone and another through the center of the distal bone. In a varus alignment, these lines would form an angle that opens laterally (away from the body's midline), meaning the distal part is angled inward.
• It is the opposite of valgus, where the distal segment angles outward (laterally) away from the midline.

Common Examples of Varus Deformities

Varus deviations can occur at various joints throughout the body, with some being more commonly recognized than others due to their functional impact.

• Genu Varum (Knee Varus or "Bow-Legged"): This is perhaps the most well-known example. In genu varum, the tibia (shin bone), which is distal to the knee joint, angles inward relative to the femur (thigh bone). When standing, the knees appear to bow outward, and there is often a noticeable gap between the knees while the ankles are together.
• Cubitus Varus (Elbow Varus): Here, the forearm (distal to the elbow) angles inward towards the body when the elbow is extended. This can sometimes be a result of a fracture in childhood.
• Pes Varus (Foot Varus): This refers to an inward deviation or inversion of the foot, where the sole of the foot turns inward. It is a component of conditions like clubfoot (talipes equinovarus).
• Coxa Vara (Hip Varus): This describes a decrease in the angle between the head and neck of the femur and its shaft, resulting in the shaft angling more medially. This can affect hip mechanics and lead to altered gait patterns.

Causes and Implications

Varus deformities can arise from various factors, including:

• Congenital conditions: Present at birth (e.g., clubfoot).
• Developmental issues: Occurring during growth (e.g., rickets leading to genu varum).
• Trauma: Fractures or injuries that heal improperly.
• Degenerative changes: Osteoarthritis can lead to varus or valgus collapse of a joint due to uneven cartilage wear.
• Musculoskeletal imbalances: Chronic muscle imbalances or weakness can contribute to or exacerbate varus alignment.

The presence of a varus alignment can have significant biomechanical implications. For example, in genu varum, the inward angulation of the tibia places increased compressive forces on the medial compartment (inner side) of the knee joint. Over time, this can accelerate cartilage degeneration and lead to medial compartment osteoarthritis. It can also alter gait mechanics, potentially affecting other joints like the hip and ankle.

Clinical Significance and Management

From a clinical perspective, identifying a varus position is crucial for diagnosis and treatment planning. Healthcare professionals, including orthopedists, physical therapists, and chiropractors, use visual assessment, goniometry (measuring angles), and imaging (X-rays) to quantify the degree of varus.

Management strategies vary depending on the severity, cause, and patient's age:

• Conservative Management: This often involves physical therapy focusing on strengthening supporting muscles, improving joint stability, gait training, and sometimes orthotics (braces or shoe inserts) to correct alignment or redistribute forces.
• Surgical Intervention: In severe cases, or when conservative measures fail, surgical correction (e.g., osteotomy to realign the bone) may be necessary to improve function, reduce pain, and prevent further joint damage.

Varus in Exercise and Rehabilitation

For fitness professionals, understanding varus positions is vital for:

• Client Assessment: Recognizing these anatomical variations during initial assessments allows for a more personalized and safe exercise prescription.
• Exercise Selection: Certain exercises might exacerbate stress on joints with varus alignment. For instance, deep squats or lunges might need modification for individuals with significant genu varum to minimize medial knee stress.
• Cueing and Technique: Instructing clients to maintain neutral alignment or to focus on specific muscle activations can help mitigate the effects of a varus deviation. For example, cueing "knees over toes" or emphasizing gluteal activation can help manage knee alignment during lower body exercises.
• Referral: Knowing when to refer a client to a medical professional (e.g., physical therapist, orthopedic surgeon) is critical if the varus position is causing pain, significantly impacting function, or appears to be worsening.

Key Takeaway

"Varus" describes an inward (medial) angulation of a distal body segment relative to its proximal segment. Recognizing and understanding varus positions, such as "bow-leggedness" at the knees, is fundamental for anyone involved in health, fitness, or rehabilitation. It informs assessment, exercise programming, and the overall approach to optimizing biomechanics and joint health.