II. Pathophysiology

  1. Normal finding in the newborn
  2. Physiologic bowing of the lower extremities
    1. External rotation of femur
    2. Internal rotation of tibia

III. Symptoms

  1. Noted first at walking age

IV. Signs

  1. Knees bow apart
  2. Typically symmetric and bilateral
  3. Measuring degree of Genu Varum
    1. Child stands with medial malleoli touching
    2. Measure distance between medial femoral condyles

V. Differential Diagnosis

  1. Rickets
  2. Skeletal dysplasia
  3. Blount's disease
    1. Obesity-related abnormal growth of medial proximal tibial physis
  4. Tibial Bowing
    1. Anterolateral bowing
      1. Neurofibromatosis association
    2. Posteromedial bowing
      1. In utero calcaneovalgus foot (will correct)
  5. High impact sports
    1. May generate Genu Varum in teens

VI. Management

  1. No management (bracing, connective bars, Orthotics) needed in most cases
  2. Surgical osteotomy may be considered in severe, non-resolving cases

VII. Course

  1. Persistence after age 2 years is atypical
  2. Often transitions to Genu Valgum (Knock-Knees)
    1. Occurs between ages 18 months to 3 years
    2. Corrects spontaneously by ages 6 to 10 years

VIII. Complications

  1. Premature Osteoarthritis

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