Bow legs in adults: signs, effects and next steps

The appearance alone does not determine whether treatment is needed. Pain, changes over time, walking difficulty, differences between the legs and signs of joint wear are more useful when planning care.

With genu varum, the knees stay separated when the ankles are placed together. The curve may have been present since growth, or become more noticeable as the knee changes. One leg can be affected more than the other.

Altered alignment can concentrate load toward one side of the knee. Some adults notice aching around the knee, fatigue when standing, a change in walking pattern, or discomfort at the hip or ankle. Others have visible bowing without limiting symptoms.

Track where pain occurs, which activities bring it on, whether swelling appears and whether the alignment seems to be changing. An orthopaedic clinician can examine standing posture, walking, joint movement and stability. Standing imaging may be used to evaluate the mechanical line of the leg and joint surfaces.

Care can include adapting aggravating activities, strengthening muscles that support the hips and knees, improving balance, and addressing footwear. These approaches may make movement easier but are not expected to remodel adult bones. For selected structural problems, an osteotomy can reposition bone and redistribute load.

Arrange a routine appointment for continuing pain, recurrent swelling, loss of knee movement, increasing bowing or a new limp. A clear difference between the legs, joint locking, or instability that interferes with work and daily tasks should also be checked.

Get urgent help if sudden severe pain follows a fall, weight-bearing becomes impossible, or the lower leg develops new numbness, weakness, unusual colour or coolness. Prompt care is also appropriate for a hot, markedly swollen joint accompanied by fever or feeling unwell.

You could ask whether the bowing comes mainly from bone alignment or joint wear, how each knee is affected, and what changes might protect function. Clarify the purpose of physiotherapy, whether imaging is useful, and what findings would make a surgical opinion reasonable.