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Bow Legs | Genu Varum

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What Are Bow Legs?

Bowing of the lower limbs and knees is a common problem that affects children and adults. The resulting deformity, bow legs, can be severe (as in Blount’s disease) or mild.


All bowing results in malalignment of the knee and ankle which often leads to joint arthritis. Bow legs is also known as genu varum or varus knees. 

bow legs surgery

Severe Bow Legs (Genu Varum)

What Causes Bow Legs?

Most bow legs are congenital. This means that people are born with the deformity and it becomes more obvious with growth. In some cases, there is a long family history of bowlegs making this a genetic variety.


Many patients are motivated to seek treatment because an older family member has always suffered from “knee problems".


Bow legs can be developmental, caused by excessive body weight or poor nutrition as in Blount’s disease or Ricketts.

Symptoms Of Bow Legs

Younger people who suffer from bow legs often don’t feel pain, but they will notice that their knees never touch when their feet are together. They may also feel as though their legs look different from everyone else's.


As people with bow legs begin to age, the abnormal stresses on the cartilage will lead to joint breakdown and painful arthritis. Pain on the inside of the knee is usually a sign of the cartilage taking most of the stress. Pain on the outside of the knee may be indicative of where the ligaments are being stretched out.


Noticeable symptoms of bowlegs include: 

  • Knee pain

  • Difficulty running or being active

  • Social anxiety over the appearance of the legs

These symptoms tend to get worse over time and although exercise and stretching may help to control pain, there is only one real option to correct the misalignment.

Knock Knees Surgery - Correction through Femur + Tibia

Bow Legs Treatment

Bow legs is a structural problem that affects the shape of the bone and must be addressed fundamentally. Surgical correction is the only way to permanently straighten bow legs.


The surgery needed depends on the age of the patient and on the severity of the bowing.  In children, the surgery is often very limited and involves a simple tethering of the growth plate inducing it to grow straight.


In adults, the tibia, and sometimes the femur bone, need to be cracked by making an osteotomy (bone cut) and pushing the bone into a straight alignment. The crack in the bone needs to be held in the correct position with metal hardware while it heals. The metal implants we use include plates, intramedullary nails, and external fixators.


Each patient is an individual with a unique alignment that requires careful evaluation and customized surgical planning. The origin of the bowing, the relative limb lengths, the presence of other deformities like rotation, and specific patient factors will weigh into the decision of which bones to correct and which metal device to use.

This individualized treatment approach has led to outstanding results. Bow legs surgery can also be performed in conjunction with limb lengthening surgery

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Severe Bow Legs (Genu Varum)

bow legs surgery

Mild Bow Legs (Genu Varum)

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Moderate Bow Legs (Genu Varum)

Bow legs surgery before and after
Limb Lengthening and bow legs Surgery

Mild Bow Legs surgery (Genu Varum) in addition to stature lengthening

Blount's Disease and Bow Legs Surgery 


Surgery is performed at the Hospital for Special Surgery in New York City. Dr. Fragomen personally performs all of the procedures and is supported by a professional surgical team. Patients are admitted to the hospital after surgery for an average of 2 nights where they will receive multimodal pain control from the HSS pain team and physical therapy for crutch training.


Patients can expect to be on crutches for about 6 weeks. Once the osteotomy site has healed, patients may resume unrestricted physical activity. Eventually the rods and plates will need to be removed in an ambulatory setting. 

Medical Questions

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