GENU VALGUS & GENU VARUS

Natural History of normal evolution of the

alignment of the lower limbs

Bowlegs in new born and infant

With medial tibial torsion = fetal position

Becomes straight by 18/12

By 2 or 3 genu valgus develop (avg. 12°)

By 7 spontaneous correction
To the normal of adult valgus ( 8°♀ and 7°♂)
 Persistent genu varum

• Worried parents

• About 3 years old +bow legs +mild lateral thrust at

the knees + in-toeing

• Assessment:
- History
- etiologic factors
 Examination
• Height

• See ( front, back & side)

• Measure
 IC distance,
 lateral thigh-leg angle,
 center of gravity

• Site of varus
 Causes
• Lateral ligament laxity
• Blount’s disease
• Congenital pseudoarthrosis of tibia
• Coxa vara
In ligamentous laxity notelat.Widening In Blount angulation at med.tib
Of knee joints metaphysis
In cong. Pseudarthrosis of tibia,the In coxa vara ,angulation at the neck shaft
angulation is in the distal ⅓ level
• Gait: intoeing, lateral thrust-the fibular head and
upper tibia shift laterally in Blount due to laxity and
incompetence of the lat. Collat. Lig.
• Stability
• Symmetry
• Level of fibular head, normally at the level
of the upper tibial growth plate, while it is proximal
in Blount, cong.longitudinal dificiency of the tibia
and achondroplasia
 X-ray

• 3 years and older

• Getting worse
• Abnormal site of
angulation
• Large physis and
epiphysis
• History – taruma, infection,
possible metal intoxication(lead or
floride)

Metaphysial/diaphysial
angle ≥ 18°
 Finding

• Metaphysis, thick and frayed

in rickets

• In physiologic genu
varum no intrinsic bone
disease, gentle curve, medial
cortices thickening, horizontal
joint lines of the knee & ankle are
tilted medially
Knock Knees / Genu Valgum

• Legs are bowed

inwards in the
standing position.
Bowing occurs at or
around the knee. On
standing with knees
together, the feet are
far apart.