When Is Osteotomy Recommended for Bow Legs?

Bow legs, also called genu varum, describe an outward curve of the legs. Mild alignment can be part of normal development, particularly in children, so age, growth and the cause matter. In an older child or adult, a fixed deformity may place extra force through one side of the knee. An osteotomy reshapes or repositions bone to bring the leg closer to a more useful mechanical alignment.

Doctors assess the whole limb, not appearance alone. Standing alignment X-rays, knee examination, limb-length assessment and symptoms help show whether surgery could improve load distribution. Growth-related treatment may differ from adult correction, and a metabolic or previous-injury cause may need attention first.

Book an orthopaedic assessment if the curve is asymmetric, painful, increasing, or affecting walking, sport or daily activities. Take earlier reports and mention injury, infection, childhood bone disease and family patterns. A clinician may recommend observation, physiotherapy for strength and movement, activity changes or treatment of the underlying cause before surgery.

If osteotomy is discussed, ask about the planned correction, fixation, weight-bearing limits and rehabilitation. Recovery is gradual: the bone must heal while nearby joints and muscles regain comfortable movement and strength.

Arrange urgent assessment after a fall with inability to bear weight, visible new deformity, severe swelling, fever with a hot joint, or rapidly increasing pain. A child with sudden refusal to walk or a rapidly changing leg shape also needs prompt review.

Is the alignment coming from the thigh, shin or both? Is it changing with growth? What does the standing X-ray show about knee loading, and what non-surgical options should we try before considering correction?