Genu Varum

A. Definition
genu varum is curvature of the tibia bone laterally (O-shape).

B. Etiology
1. physiology:
according age:
-First year: Lateral bowing Tibiae
-Second year: Bow legs (knees & tibiae)
-Between ages 2- 4: Knock knees
(usually marked with conditions: symmetrical between left and right)
2. Pathological:
• Rickets: Rickets occurs due to a lack of vitamin D which helps absorption of calcium and phosphorus from the blood to
harden bones. This disease occurs in children. Ricketsia causes leg bones to grow bent.
• Trauma: Fractures in the distal femur or proximal tibial fractures
• Blount disease (tibia vara or osteocondrosis deformans tibia) is a developmental condition, which is characterized by
impaired endochondral ossification in the medial physical (epiphyseal plate) of the proximal tibia resulting in multiplanar
deformity of the lower limb

C. Clinical manifestations
a. The shape of the foot like the letter X
b. Knee pain
D. Pathophysiology
-Normal alignment: symmetrical lower extremity length
-The mechanical axis (center of gravity) divides the knee into 2 equal parts when the patient stands with the
patella facing forward. This position provides relatively balanced pressure in the medial and lateral
compartments
-In genu valgum, mechanical axis deviation occurs laterally and causes pathological stress due to the burden
supported by the femur and the lateral tibia.
-Emphasis on the area results in the Heueter-Volkmann effect, namely "compression across the growth plate
slows longitudinal growth". Growth inhibition occurs in bone epiphyses that inhibit normal bone expansion
E. Diagnosis
-Physical examination
a. Inspection
The shape of the foot like the letter X
Pes planus and external tibia torsion
b. Standing position
Femoral-tibial angle: <7-8o
Intermaleolar distance: away
c. Running position: the angle at the knee when stepping toward the medial (medial thrust)
d. Supination position
Mechanical axis shifts laterally (tibia external torque)
Internal hip rotation is inhibited
e. LLD (True length and appearance length): limb length discrepancy
f. Measurement between medial maleolus
Valgum: <8 cm
- Supporting investigation
a. Radiology: AP Photo from hip to ankle
F. Management
• Genu varum and genu valgum physiology (usually occurs at age <2 years) will usually improve spontaneously and management
is only in the form of observation.
• If there is no improvement and can be made worse:
1) KAFO (Knee Ankle Foot Orthosis)
Before age 3, knee-ankle-foot-orthosis (KAFO) is used for 23 hours a day.
2) osteotomy realignment surgery

G. Complications
a. Untreated valgum genu
Continual pain, Inflammation of degenerative patoral femoral joints
b. Post-op complications
Early
Hematom,Infection, Compartment syndrome ,Slow, Keloid / scar, Over correction, Recurrent deformity

H. Prognosis
Genu valgum physiological will improve with growth and development.
Pathological valu genu: operative success is determined by the ability of the epiphyseal attachment
Recurrent deformity can occur