Varus: Definition, Causes, Symptoms, and Management

What is Varus?

Varus refers to an angulation of a distal bone segment or joint away from the midline of the body, causing an inward bowing or deviation. It is an anatomical term used to describe a specific type of deformity or alignment where the angle formed by two segments points medially.

Understanding Anatomical Terminology

In anatomy and kinesiology, precise terminology is crucial for describing body positions, movements, and alignments. When discussing deviations like varus, it's helpful to recall fundamental anatomical concepts:

• Medial: Towards the midline of the body.
• Lateral: Away from the midline of the body.
• Distal: Further from the point of attachment or origin of a limb.
• Proximal: Closer to the point of attachment or origin of a limb.

Varus describes a situation where the distal part of a limb or segment is angled inward, towards the midline, relative to the more proximal part.

Defining Varus

Varus is an angular deformity where the apex of the angle points away from the midline, resulting in the distal segment deviating inward. This creates an "bow-legged" appearance when referring to the lower limbs, or a similar inward angle in other joints.

It is often contrasted with valgus, which is the opposite condition. In a valgus deformity, the distal segment deviates outward, away from the midline, creating a "knock-kneed" appearance. For example, Genu Varum means the knees bow outward, while Genu Valgum means the knees knock inward.

Common Examples of Varus Deformities

Varus conditions can affect various joints throughout the body. Some of the most commonly recognized examples include:

• Genu Varum (Bowlegs): This is perhaps the most well-known varus deformity, characterized by an outward bowing of the legs at the knees, meaning the distal part of the leg (lower leg) angles inward relative to the thigh. This places increased stress on the medial (inner) compartment of the knee joint.
• Cubitus Varus (Gunstock Deformity): An elbow deformity where the forearm is angled inward towards the body, resembling a gunstock when the arm is extended. This often occurs after a supracondylar fracture of the humerus in childhood.
• Hallux Varus: A less common condition than its opposite (hallux valgus or bunion), where the big toe deviates medially, away from the second toe.
• Forefoot Varus: A condition of the foot where the forefoot (front part of the foot) is inverted (angled inward) relative to the rearfoot (heel) when the subtalar joint is in its neutral position. This can significantly impact gait mechanics and contribute to compensatory movements.

Causes of Varus Conditions

The etiology of varus deformities can be diverse, ranging from congenital factors to acquired conditions:

• Congenital Factors: Some individuals are born with varus alignment due to genetic predisposition or developmental issues during gestation.
• Developmental Conditions:
  • Rickets: A condition caused by prolonged vitamin D deficiency, leading to softening and weakening of bones, which can result in bowed legs (genu varum) in children.
  • Blount's Disease (Tibia Vara): A growth disorder affecting the growth plate of the tibia (shin bone) near the knee, causing the lower leg to bow outward.
• Trauma and Injury: Fractures, especially those involving growth plates in children or severe ligamentous injuries, can heal with a malunion or altered joint mechanics leading to varus angulation.
• Degenerative Conditions:
  • Osteoarthritis: Particularly in the knee, long-standing osteoarthritis can lead to cartilage loss primarily on the medial side, causing the joint to collapse into a varus alignment.
• Muscular Imbalances and Weakness: Chronic imbalances in muscle strength and flexibility around a joint can contribute to or exacerbate varus alignments over time. For example, weakness in hip abductors or external rotators can influence knee alignment.
• Biomechanical Factors: Abnormal foot mechanics, such as excessive supination or forefoot varus, can lead to compensatory movements higher up the kinetic chain, influencing knee and hip alignment.

Symptoms and Clinical Presentation

The symptoms associated with a varus condition vary depending on the affected joint and the severity of the deformity:

• Visible Deformity: The most obvious sign is the characteristic inward angulation or bowing of the limb segment.
• Pain: Localized pain in the affected joint, often on the side that is experiencing increased compression (e.g., medial knee pain in genu varum).
• Altered Gait and Movement Patterns: Varus deformities can significantly impact walking, running, and other functional movements, leading to compensatory strategies and inefficient mechanics.
• Joint Instability: While less common than with valgus, severe varus can sometimes lead to feelings of instability.
• Reduced Range of Motion: The angulation can limit the joint's ability to move through its full physiological range.
• Accelerated Joint Degeneration: The altered load distribution can accelerate wear and tear on cartilage and menisci, increasing the risk of osteoarthritis.

Implications for Exercise and Movement

For fitness professionals and individuals engaging in physical activity, understanding varus alignment is crucial due to its biomechanical consequences:

• Altered Joint Loading: A varus alignment shifts the primary load-bearing forces to the medial compartment of the joint. In the knee (genu varum), this means increased compression on the medial meniscus and articular cartilage, predisposing individuals to medial compartment osteoarthritis and medial meniscus tears.
• Compensatory Patterns: The body will often compensate for a varus alignment, leading to altered muscle activation patterns and stress on other joints or soft tissues. For example, individuals with genu varum might exhibit increased external rotation of the tibia or altered foot pronation patterns.
• Increased Injury Risk: Specific exercises or movements that heavily load the affected joint, especially those involving impact or twisting, can exacerbate symptoms or increase the risk of injury to the compressed side of the joint.
• Exercise Modifications: Individuals with varus deformities may need modified exercise programming. This could include:
  • Strengthening: Focusing on muscles that help to correct or stabilize the alignment (e.g., hip abductors and external rotators for genu varum, or specific foot intrinsics for forefoot varus).
  • Stretching: Addressing any muscle tightness that contributes to the deformity.
  • Load Management: Reducing high-impact activities or adjusting resistance training to minimize stress on the affected joint compartment.
  • Proprioception and Balance Training: Improving neuromuscular control around the joint.
• Footwear and Orthotics: For lower limb varus, appropriate footwear and custom orthotics can play a significant role in managing symptoms and improving biomechanics by influencing foot posture and ground reaction forces.

Diagnosis and Management

Diagnosis of a varus condition typically involves a comprehensive clinical examination by a healthcare professional (e.g., orthopedic surgeon, physical therapist). This includes assessing gait, range of motion, muscle strength, and visual inspection of the alignment. Imaging studies such as X-rays are often used to confirm the diagnosis and measure the degree of angulation.

Management strategies depend on the cause, severity, and patient's symptoms:

• Conservative Management:
  • Physical Therapy: Exercises to improve strength, flexibility, balance, and gait mechanics.
  • Orthotics and Bracing: Custom shoe inserts or knee braces can help redistribute forces and support alignment.
  • Pain Management: Medications or injections to alleviate symptoms.
• Surgical Intervention: In severe cases, or when conservative measures fail, surgical procedures like osteotomy (cutting and realigning the bone) may be performed to correct the alignment and preserve joint function.

Conclusion

Varus is a critical anatomical term describing an inward angulation or bowing of a distal limb segment. While it can manifest in various joints, its implications for the knee (genu varum) are particularly significant for fitness and health due to altered biomechanics and increased risk of osteoarthritis. Understanding varus alignment is essential for fitness professionals to design safe, effective, and individualized exercise programs, recognize potential risks, and refer clients to medical professionals when appropriate. Proper assessment and management can help mitigate pain, improve function, and enhance long-term joint health.