Genu varum is a deformation of the knees marked outwards, which means that the lower leg is inclined inwards in relation to the axis of the thigh, giving the lower limb the appearance of an arch. Usually, the medial angulation (deviation) of the bones of the lower limbs is involved, respectively the femur and the tibia, more precisely the tibia (calf bone) is deviated inwards instead of aligning with the femur (thigh bone). This causes the knees to turn outwards.

The relation between the position of the femur and tibia is called tibiofemural alignment. Ideally, the two bones should form an alignment of 180 degrees. If there is a deviation of only a few degrees, it is possible that no symptoms will appear for years.

Genu varum or knee in varus, is normal among newborns.

The knee joints of newborns are still developing and many of their bones have not yet moved to their permanent position.

However, some young children may develop genu varum as a result of rickets, a condition associated with low levels of vitamin D, causing soft bones.

In adults, osteoarthritis can be both the result and the cause of the genu varum.

If the cartilage inside the knee joint wears out, it can cause the tibia to deflect inwards.

Other possible causes of the genu varum include:

➢ Infections or bone tumors
➢ Injuries or fractures viciously strengthened
➢ Paget bone disease (bone skeletal disorder that manifests itself with bone hypertrophy and decreased bone tissue density)
➢ Fragile bones disease (incomplete formation of bones)
➢ Achondroplasia (genetic disorder whose main feature is dwarfism, in which the upper and lower limbs are shorter)

The most obvious symptom of the genu varum is the arched legs.

Adults may also feel localized pain on the internal part of the knee, while young children may not have symptoms.

Over time, untreated genu varum can cause joint pain, especially while walking. It can also cause unusual wear of the articular cartilage in the knees, which can lead to osteoarthritis.

A physical examination in which the position of the lower limbs is verified both in orthostatic position (standing) as well as while walking, is relevant for the diagnosis of the genu varum. Also, an x-ray of the lower limbs is important for a clearer picture of the bone structure.

An instrument called a goniometer can be used to measure the degree of deviation.

In the case of children with arched legs, it is recommended to test the level of vitamin D, to exclude rickets. The earlier a pshycian is consulted for diagnosis and treatment, the less the knee suffers.

Treatment in genu varum depends on the triggering cause.

In young children, it generally remits itself, being normal among newborns.

The treatment is indicated when genu varum persists over the age of 3 and a half years.Thus:

➢ When genu varum is caused by rickets, vitamin D and calcium supplements are administered. At the same time, it is recommended to start the recovery program.

➢ Physical therapy
Through special programs of active exercises and stretching exercises, mobilizing and toning the muscles adjacent to the knee joint is pursued in order to increase mobility and joint stability.

➢ Manual therapy and personalized shoe bands help correct possible inequality of lower limbs and/or to correct possible deformations of the plantar arch.

➢ Surgery
It’s necessary when deformity occurs in adults, either because of a trauma or because of the job. The most common type of surgery used to treat genu varum is high tibial osteotomy. This procedure realigns the tibia by cutting and reshaping it, leading to the relief of pressure on the knee. Tibial osteotomy can also help to prevent or at least delay, the need for total knee replacement surgery.
After the period of immobilization post-operatively, in which it is necessary to immobilize the lower limb in plastered apparatus or in plastered splints or orthoses, it is recommended to start the physical therapy program.
After tibial osteotomy surgery, current daily activities can be resumed after about three to eight months.