Physiologic bow leg deformity should spontaneously correct by two years of age. No x-rays are usually necessary before then. Internal tibial torsion and external rotation contracture of the hips often accompany genu varum and tend to accentuate the deformity. In most instances, this deformity is not recognized until the child begins to walk. At that time, the parents become quite concerned about the wide space between the knees, the waddling gait, and the toeing-in.
Treatment is reassurance and observation.
Shoe corrections, splints and exercise programs do not produce any change different than the normal expected spontaneous correction. Moreover, use of a Denis Browne bar might exaggerate the physiologic genu valgum and pronated feet that normally occur following the spontaneous resolution of the bow leg deformity Pathologic bow leg deformities may produce serious problems. Factors suggestive of pathologic conditions include failure of genu varum to correct by age two years, increasing deformity, unilateral bowleg, and a marked lateral thrust with weight bearing. Blount's Disease is probably the most common cause of pathologic bow leg deformity. This is a disturbance of the medial aspect of the proximal tibial growth plate, resulting in a structural genu varum.