GenuVarumClinicGuidelinesOrthopaedicPractice

Definition
Angulardeformityoftheproximaltibiainwhichthechildappearsbowlegged

Pathogenesis/NaturalHistory

Contractureofthemedialkneecapsuleduetoinuteroposition.Duringthefirstyearofdevelopmentthis
internalrotationcontractureleadstoexternalrotationoftheentirelowerlimbandtheclinicalgenuvarum
postureoftheinfant(3)
Spontaneousresolutiontypicallybeginsby1822months,correctioncontinuesoverthenext23yearsand
overcorrectiontoamaximumgenuvalgumisseenbetween3.54years.Thevalgusanglethendecreasestothe
adultdegreeofvalgusbetween7and11yearsofage.(3)

ClinicalPresentation
Genuvarumthathaspersistedafter18monthsofage,usuallypronouncedbythechildbeginningambulation

Evaluation

Screenfordevelopmentaldelay
Familyhistory:shortstature,angularkneedeformities?
Hasproblemimproved,gottenworse,stayedthesame?
Measurethechildsheightandweight
Measurementoffemoraltibialangle
Neuromuscularexam

DifferentialDiagnosis

HypophosphatemicRickets
Physiologicbowlegs
Blounts
Pseudoachondroplasia
Focalfibrocartilaginousdysplasia
Osteogenesisimperfect

DiagnosticTests

Radiographs
o Severegenuvarumforage
o Heightlessthanthe25thpercentile
o Excessiveinternaltibialtorsion
o Increasinggenuvarum
o Unilateral/asymmetryoflimbalignment
o Lateralthrust
o Pain
o Abnormalhipexam

ApprovedBy:AllisonDueyHoltz,MSN,APNP
Date:March15,2012
OfficePhone:4143377300

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Radiographiccharacteristics:APstandinglowerextremities
o Symmetricalinvolvement
o Normalappearinggrowthplate
o Medialbowingthatinvolvestheproximaltibiaandthedistalfemur
o Metaphyseal/DiaphysealAngle
LaboratoryEvaluation
CMP
CBCwithdifferential
IonizedCalcium
PTH
25HydroxyVitaminD
I25DehydroxyVitD

TreatmentOptions

Explanationofnormalkneedevelopment
Education
o Explanationthatshoemodificationsandbracingareineffective
o Explanationthatinanotherwisenormalchild,thisconditionwillspontaneouslycorrectitself
o Reviewsignsofdevelopinggenuvarumforfamilytolookfor(ieunilateral,lateralthrust,worsening
appearance,notresolvingbyage2yo)

FollowupRecommendations

FollowupwithPA/NPasneeded
o ifgenuvarumisdeemedage/developmentallyappropriatebutPA/NPorfamilywouldlikefollowup
o 4monthsifmetaphysealdiaphysealanglebetween1015degrees
Referraltoendocrineforabnormallaboratoryevaluation(ierickets)
Followupwithsurgeon
Ifmetaphyseal/diaphysealanglegreaterthan15degreesand/orlateralthrust
Progressive
Underlyingpathologycausinggenuvarum

EvidencedBasedLiteratureReview
1.

2.

3.

4.

Greene,W.B.(1996).Genuvarumandgenuvalguminchildren:Differentialdiagnosisandguidelinesforevaluation.Current
OpinioninPediatrics,22(1),2229.

Health,C.H.&Staheli,L.T.(1993).NormallimitsofkneeangleinwhitechildrenGenuvarumandgenuvalgum.Journalof
PediatricOrthopedics,13,259262
Do,T.T.(2001).Clinicalandradiographicevaluationofbowlegs.CurrentOpinioninPediatrics,13(1),4246.
Zionts,L.E.&Shean,C.J.(1998).Bracetreatmentofearlyinfantiletibiavara.JournalofPediatricOrthopedics,18(1),102109.

ApprovedBy:AllisonDueyHoltz,MSN,APNP
Date:March15,2012
OfficePhone:4143377300

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