Knee surgery for bow legs: what to know

Bow legs, also called genu varum, describe outward curvature between the knees and ankles when the legs are viewed together. Alignment can be a normal stage in childhood, while persistent or progressive bowing may shift load toward one side of a knee. Pain, walking difficulty, unequal leg length, instability or signs of joint wear make assessment more relevant. The decision depends on the whole leg rather than the knee appearance alone.

An orthopaedic assessment may include walking observation, joint examination and standing alignment X-rays. Children may be monitored as growth changes the shape; paediatric physiotherapy can support strength, balance and movement when indicated, but it does not straighten a fixed bony angle. When correction is appropriate, an osteotomy reshapes or repositions bone to improve the mechanical axis. The surgeon should explain the target, fixation, rehabilitation and alternatives in relation to the individual case.

Arrange assessment for progressive bowing, one-sided deformity, pain, limping, repeated falls, reduced activity or a noticeable difference in leg length. Seek prompt care after an injury causing sudden deformity, inability to bear weight, severe pain or loss of sensation.

Ask whether the alignment is expected for age, where the load is concentrated, and whether standing imaging is needed. If surgery is discussed, ask about the correction goal, fixation, recovery milestones, physiotherapy and how growth or future joint health affects timing.