Home Pediatric OrthopaedicsBow Legs Correction (Genu Varum) in India

Bow Legs Correction (Genu Varum) in India

Specialized surgical correction for bow-shaped legs in children and adults, restoring normal limb alignment and preventing long-term joint complications.

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Overview

Bow legs correction, medically known as genu varum correction, is a comprehensive treatment approach for legs that curve outward at the knees. Dr. Gurudeo Kumar at Arthoscenter Patna brings over 15 years of specialized expertise in pediatric and adult limb deformity correction, having successfully treated over 350 patients with bow legs using both conservative and advanced surgical techniques. Our facility maintains a 97% success rate in achieving optimal leg alignment and preventing future complications. Bow legs (genu varum) presents as an outward bowing of the legs, where the knees remain apart even when the ankles are together. While physiological bow legs in infants under 24 months typically self-correct, pathological bow legs require medical intervention. Common causes include rickets (vitamin D deficiency), Blount's disease, skeletal dysplasias, previous fractures, and metabolic bone disorders. In Bihar, where rickets remains prevalent due to nutritional deficiencies and limited sun exposure, early identification and treatment are crucial. At Arthoscenter, we offer a complete spectrum of treatment options tailored to each patient's age, severity, and underlying cause. For growing children, guided growth using 8-plates or tension band plating provides minimally invasive correction by temporarily modulating growth on one side of the bone. For severe deformities or skeletally mature patients, corrective osteotomy (surgical bone cutting and realignment) delivers precise, permanent correction. Dr. Kumar's expertise in both techniques ensures optimal outcomes with minimal complications, faster recovery, and excellent cosmetic results. Our patient-centered approach includes comprehensive evaluation with full-length standing radiographs, detailed mechanical axis measurements, nutritional assessment, and personalized treatment planning. We provide family education in both Hindi and English, addressing concerns specific to Bihar's cultural context. Post-operative care includes specialized pediatric rehabilitation, regular monitoring, and long-term follow-up to ensure maintained correction and healthy joint development.

Symptoms & Indications

This surgery may be recommended if you experience:

Outward bowing of legs with knees remaining apart (more than 6 cm gap) when ankles are together

Asymmetric leg alignment - one leg curves more than the other

Progressive worsening of bowing after age 2 years instead of improvement

Abnormal walking pattern with lateral thrust or wide-based gait

Knee pain or discomfort during walking, running, or prolonged standing

Difficulty with activities requiring leg alignment such as cycling or sports

Visible knee joint stress with medial compartment overload

Short stature or growth delays compared to age-matched peers

Associated signs of rickets: wrist/ankle swelling, delayed fontanelle closure, rachitic rosary

Family history of bow legs, Blount disease, or metabolic bone disorders

Procedure Details

Duration

1.5 to 3 hours depending on technique (guided growth: 45-60 minutes per leg; osteotomy: 2-3 hours)

Anesthesia

General anesthesia with pediatric anesthesiologist, using age and weight-appropriate protocols with continuous monitoring

Preparation for Surgery

Pre-operative preparation begins 2-3 weeks before surgery with comprehensive evaluation including full-length standing radiographs, mechanical axis deviation measurements, nutritional assessment (vitamin D, calcium, phosphate levels), and metabolic screening. Patients with rickets receive 6-8 weeks of vitamin D and calcium supplementation to optimize bone quality. Complete blood count, coagulation profile, and pediatric anesthesia consultation are performed. Parents receive detailed education about the procedure, expected outcomes, and post-operative care in their preferred language. Children are admitted one day before surgery with pre-anesthetic evaluation and nil-by-mouth instructions (6 hours for solids, 2 hours for clear fluids). Medical photography and consent documentation are completed.

Surgical Steps

Anesthesia Administration: General anesthesia is induced with age-appropriate pediatric protocols. For guided growth procedures, the patient is positioned supine on a radiolucent table. For osteotomy, careful positioning with all pressure points padded is ensured. Prophylactic antibiotics (cefazolin 25mg/kg) are administered 30 minutes before incision.

Surgical Approach Selection: For guided growth (8-plate technique), small 2-3 cm incisions are made medially at the proximal tibia and distal femur physis. For corrective osteotomy, a larger 6-8 cm incision is made over the deformity site with careful soft tissue dissection protecting neurovascular structures.

Fluoroscopic Guidance and Plate Positioning: Under C-arm fluoroscopy, guide wires are placed perpendicular to the growth plate on the medial (convex) side. For 8-plates, two screws are inserted above and below the physis, connected by a tension band plate. The compression created gradually corrects the angulation over 6-18 months as the lateral side continues growing.

Osteotomy Execution (if required): For severe deformities or older children, a closing wedge or opening wedge osteotomy is performed at the level of maximum deformity (usually proximal tibia). Bone cuts are made precisely using oscillating saw under continuous irrigation. The deformity is corrected to achieve 0-6 degrees of physiologic valgus.

Bone Realignment and Fixation: The bone is realigned to restore mechanical axis (line from femoral head center through knee center to ankle center). Internal fixation is achieved using locking plates and screws. For opening wedge osteotomy, bone graft or bone substitute is placed in the gap. Fluoroscopic images confirm proper alignment in both AP and lateral views.

Hardware Security and Stability Testing: All screws are tightened sequentially with appropriate torque. Plate position is verified fluoroscopically. For guided growth, minimal hardware is used (8-plate requires only 2 screws per physis). For osteotomy, stability is tested with gentle stress while monitoring fixation integrity.

Wound Closure and Dressing: Deep fascia is closed with absorbable sutures (Vicryl 2-0). Subcutaneous layer is approximated, and skin is closed with subcuticular sutures for minimal scarring. Sterile dressing is applied with mild compression. Above-knee cast or brace may be applied for osteotomy cases based on stability.

Post-procedure Assessment: Final fluoroscopic images document correction achieved and hardware position. Neurovascular status is assessed (dorsalis pedis pulse, toe movement, sensation). The patient is transferred to recovery with appropriate pain management protocols. Parents are shown post-operative X-rays and educated about expected recovery timeline and rehabilitation milestones.

Recovery Timeline

What to expect during your recovery journey

Week 1-2

Hospital Stay and Initial Recovery

Hospital stay of 2-4 days for osteotomy (1 day for guided growth). Pain management with IV/oral analgesics. Above-knee cast or brace for osteotomy patients. Toe-touch weight bearing with walker/crutches. Elevation and ice therapy to reduce swelling. Daily wound inspection and dressing changes. Early ankle/foot exercises to prevent stiffness.

Week 3-6

Progressive Mobilization

Transition to partial weight bearing (25-50%) with assistive devices. Cast change or adjustment if needed. Suture removal at 2 weeks. Gentle knee range of motion exercises under supervision. Continued pain management with oral medications. Weekly follow-up visits with X-rays to monitor healing. Physical therapy begins for muscle strengthening.

Week 7-12

Active Rehabilitation Phase

Gradual increase to full weight bearing (osteotomy patients). Cast removal at 6-8 weeks with protective brace. Intensive physiotherapy for knee flexion/extension and muscle strengthening. Proprioceptive and balance training. Independent walking without assistive devices (most patients). Monthly X-rays to assess bone consolidation and alignment maintenance.

Month 4-6

Return to Daily Activities

Full weight bearing without support. Return to school or regular activities with precautions. Advanced strengthening exercises including resistance training. Gradual return to sports-specific activities (non-contact). Complete bone healing confirmed on X-rays. Brace discontinuation for most patients.

Month 7-12

Sports Readiness and Monitoring

Clearance for contact sports after 9-12 months. For guided growth patients, regular monitoring (every 3 months) to track correction progress. Hardware removal planned when correction achieved (typically 12-18 months for 8-plates). Continued strengthening and conditioning programs. Assessment for symmetric leg length and alignment.

Year 1-2

Long-term Follow-up

Annual follow-up visits with standing radiographs. Growth monitoring in pediatric patients to ensure maintained correction. Assessment for any recurrence or overcorrection. Complete hardware removal after skeletal maturity if not already done. Evaluation of gait pattern, joint alignment, and functional outcomes. Long-term prognosis counseling and activity guidance.

Tips for Faster Recovery

Maintain strict non-weight bearing or partial weight bearing as instructed to prevent hardware failure or loss of correction

Follow prescribed vitamin D and calcium supplementation religiously, especially important in Bihar where deficiency is common

Attend all scheduled physiotherapy sessions to optimize muscle strength, range of motion, and prevent stiffness

Keep the surgical site clean and dry; watch for signs of infection (increased pain, redness, fever, drainage)

Ensure adequate protein intake (eggs, dal, milk, chicken) to support bone healing and muscle recovery

Use properly fitted footwear with good arch support; avoid barefoot walking during early recovery

Practice prescribed home exercises daily between physiotherapy sessions to maximize recovery

Maintain regular follow-up appointments for X-ray monitoring, especially critical in guided growth cases

Avoid high-impact activities, jumping, or running until cleared by Dr. Kumar (typically 6-9 months)

For parents: maintain a growth diary documenting height, alignment changes, and functional milestones; early detection of overcorrection allows timely hardware removal

Frequently Asked Questions

Common questions about this procedure

Q1.At what age should bow legs be treated surgically?

The timing depends on the cause and severity. Physiologic bow legs in infants typically self-correct by age 18-24 months and require only observation. Persistent bow legs beyond age 2-3 years, progressive worsening, or pathologic bow legs (Blount disease, rickets) may require earlier intervention. Guided growth (8-plates) is most effective between ages 3-13 years when significant growth remains. For skeletally mature adolescents or adults, corrective osteotomy is the treatment of choice. Dr. Kumar evaluates each child individually, considering age, growth potential, deformity severity, and underlying cause to determine optimal timing. Early intervention prevents permanent growth plate damage and future arthritis.

Q2.What is the difference between guided growth and osteotomy for bow legs correction?

Guided growth uses small metal plates (8-plates) placed across the growth plate on the medial side of the knee to temporarily slow growth on that side while lateral growth continues, gradually straightening the leg over 12-18 months. It is minimally invasive, requires small incisions, and works best in growing children (ages 3-13) with moderate deformities. Osteotomy involves surgically cutting the bone, realigning it to the correct angle, and fixing it with plates and screws. It provides immediate correction, works for severe deformities and adults, but requires larger incisions and longer recovery. Dr. Kumar chooses the appropriate technique based on your child's age, remaining growth, and deformity severity to achieve the best outcome.

Q3.How long does it take for bow legs to straighten after guided growth surgery?

Guided growth correction is a gradual process that typically takes 12-18 months, though this varies based on the child's age, growth rate, and initial deformity severity. Younger children with faster growth rates may achieve correction in 9-12 months, while older children approaching skeletal maturity may require 18-24 months. Regular follow-up X-rays every 3 months are essential to monitor progress. Once adequate correction is achieved, the 8-plates are removed in a simple day-surgery procedure to allow symmetric growth to resume. Overcorrection is possible if plates are left too long, which is why Dr. Kumar monitors patients closely throughout the correction period.

Q4.Is bow legs correction painful for my child?

Pain levels vary by procedure type. Guided growth (8-plate) surgery involves minimal pain due to small incisions and limited tissue disruption; most children are comfortable with oral pain medications within 2-3 days and can walk with support within a week. Osteotomy involves more significant bone work and typically causes moderate pain for the first 1-2 weeks, managed effectively with prescribed analgesics. At Arthoscenter, we use pediatric-specific pain management protocols including regional nerve blocks, multimodal analgesia, and child-friendly pain assessment tools. Most children adapt well with proper pain control, physiotherapy, and family support. Dr. Kumar ensures minimal trauma surgical techniques and comprehensive pain management to make the experience as comfortable as possible.

Q5.What is the success rate for bow legs correction at Arthoscenter?

Dr. Kumar has achieved a 97% success rate in bow legs correction across over 350 cases using both guided growth and osteotomy techniques. Success is defined as achieving normal mechanical axis alignment (0-6 degrees valgus), correction maintained at skeletal maturity, and patient/parent satisfaction with cosmetic and functional outcomes. Factors influencing success include correct diagnosis of underlying cause, appropriate technique selection, optimal surgical timing, patient compliance with weight-bearing restrictions, and regular follow-up. Our comprehensive approach addresses nutritional deficiencies (common in Bihar), provides individualized treatment plans, and ensures meticulous surgical execution. Complications such as infection, hardware failure, or recurrence occur in less than 3% of cases and are managed promptly when they arise.

Q6.Will my child need to wear a cast after bow legs surgery?

Casting requirements depend on the surgical technique. For guided growth (8-plate) surgery, a cast is typically not required; most children use a knee immobilizer or light brace for 1-2 weeks for comfort, then transition to normal activities with gradual weight bearing. For osteotomy surgery, an above-knee cast or long leg brace is usually applied for 6-8 weeks to protect the bone healing and maintain alignment. The cast may be changed once at 3-4 weeks for adjustment. After cast removal, a protective brace may be used during the transition to full weight bearing. Dr. Kumar individualizes post-operative immobilization based on the specific procedure, bone quality, fixation stability, and the child's age and cooperation level.

Q7.Can bow legs come back after surgery?

Recurrence is uncommon but possible, particularly in certain conditions. For physiologic bow legs corrected with guided growth, recurrence is rare (<2%) if correction is achieved before growth plate closure and plates are removed timely. In Blount disease (especially infantile type), recurrence rates are higher (10-15%) and may require repeat surgery or alternative techniques. Rickets-related bow legs rarely recur if the underlying vitamin D/calcium deficiency is adequately treated and maintained. Osteotomy in skeletally mature patients provides permanent correction with minimal recurrence risk. Dr. Kumar minimizes recurrence through accurate diagnosis, addressing underlying causes (nutritional supplementation, metabolic treatment), appropriate technique selection, and long-term monitoring until skeletal maturity. Patients receive detailed home exercise programs and nutritional counseling to support maintained correction.

Q8.What causes bow legs in children, and is it common in Bihar?

Bow legs can be physiologic (normal variation in infants) or pathologic (disease-related). Physiologic bow legs are universal in infants, typically correcting by age 2. Pathologic causes include rickets (vitamin D deficiency), Blount disease (growth plate disorder), skeletal dysplasias, and metabolic bone diseases. In Bihar, rickets remains a significant cause due to limited sun exposure (cultural practices, indoor lifestyle), dietary calcium/vitamin D deficiency (limited dairy, vegetarian diet), and lack of fortification programs. Dr. Kumar estimates 30-40% of pathologic bow legs cases at Arthoscenter are rickets-related, higher than national averages. Comprehensive evaluation includes nutritional assessment, vitamin D/calcium/phosphate levels, and parathyroid hormone testing. Treatment addresses both the deformity and underlying deficiency through supplementation, dietary counseling, and sun exposure recommendations.

Q9.How much does bow legs correction surgery cost, and is it covered by insurance?

Treatment costs vary based on the surgical technique and individual factors. Guided growth (8-plate) surgery typically costs Rs. 80,000-1,20,000 per leg including implants, hospital stay, and initial follow-up. Osteotomy with internal fixation ranges from Rs. 1,50,000-2,50,000 per leg depending on complexity, bone grafting needs, and length of stay. These estimates include surgeon fees, anesthesia, implants, hospital charges, physiotherapy, and 3-month follow-up. Most health insurance policies and government schemes (Ayushman Bharat, state health insurance) cover pediatric orthopedic corrective surgeries with pre-authorization. Arthoscenter's billing team assists with insurance claims and documentation. We also offer flexible payment plans to ensure financial considerations don't prevent children from receiving necessary treatment. Dr. Kumar discusses all costs transparently during consultation and helps families explore financial assistance options.

Q10.When can my child return to school and sports after bow legs surgery?

Return to activities is gradual and technique-dependent. For guided growth surgery, children typically return to school within 1-2 weeks with activity modifications (no running, jumping, or contact sports). Light sports like swimming can resume at 4-6 weeks, with full sports clearance at 3 months for non-contact activities. Contact sports should wait until plate removal (typically 12-18 months post-surgery). For osteotomy, school return occurs at 4-6 weeks with cast/brace, transitioning to normal classroom activities at 8-12 weeks. Sports participation begins at 4-6 months with non-impact activities (swimming, cycling), progressing to full contact sports clearance at 9-12 months after confirmed bone healing and strength recovery. Dr. Kumar provides individualized activity timelines based on X-ray healing progress, pain levels, and functional recovery. Premature return to high-impact activities risks hardware failure or loss of correction.

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