Genu Varum – Managing with Physiotherapy

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GenuVarum

Genu varum – This condition is called bow knees because both the knees appear to have bent inside each other instead of the normal slightly outer presentation.

It is one of the common angular lower limb deformity among the children and aged people. In easy words to describe the bow knees (genu varum) is the deformity marked by medialangulation of the leg in relation to the thigh; an outward bowing of the legs.

Causes of Genu Varum

Among children:

  • Birth defect
  • Postural abnormality
  • Developmental defect
  • Rickets
  • Hormonal disorders

Among aged people:

  • Degenerative disorders like osteoarthritis of knee
  • Occupational disorders
  • Some diseases of knee like paget disease

In some cases this deformity might be present in one leg and the causes may be

  • Infection in bone like osteomyelitis
  • Trauma near the growth epiphysis of femur
  • Tumor affecting the lower end of femur and upper end of tibia and etc.

This problem is more common in elderly femals due to degeneration of the knee joints that is called osteoarthritis of the knee. The primary deformity in genu varum is inward bending of the knee. In response to this, secondary deformities develop in the tibia and the foot.

  • Patient complains of pain during walking, standing etc
  • Limp may be present
  • Difficulty in carrying activities of daily living.
  • Difficulty in squatting on the ground to perform pujas etc

Medical Management for Genu Varun

Before 4 years of age:

  • Treatment is non-operative (conservative) until four years of age
  • Knee-ankle-foot orthosis with the medial bar and the lateral strap are used
  • Correction of early deformity is done by dynamic bracing or splints
  • After four years, significant deformity should be corrected by surgery

After 4 years of age:

  • The treatment in this age group is mainly surgical and consists of the following methods:
  • Stapling the outer aspect of the knee when the child is within the growth period and
  • Cutting the outer portion of the tibia and straightening that is called tibial osteotomy or high
  • tibial osteotomy and could be either medial open or lateral closed wedge osteotomy and is done after the child attains skeletal maturity.
  • In Genu varum due to osteoarthritis of the knee in very advanced cases, the joints are replaced and is called total knee replacement surgeries
  • If only inner half of the joint is replaced it is called Unicondylar knee replacement and if all the three chambers of the joints are damaged, then the entire knee joint is replaced and is called the total knee replacement.

Physiotherapy Management 

  • Avoid or minimize weight bearing activities with knee bend and reduce body weight to reduce joint loading
  • In the presence of joint effusion high voltage pulsed galvanic stimulation, Interferential therapy, strong faradic electrical stimulation or TENS can be used for pain relief
  • When knee movements are limited in capsular pattern traction, capsular stretching, soft tissue massage, mobilization techniques etc are useful to stretch the tight capsule
  • Stretching of hamstrings, TA, hip adductors, hip external rotators is also essential to relief pain and re-orientation of the joint
  • Strengthening of the quadriceps and hamstrings also helps in deloading the joint and provides joint protection

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