ABSTRACT
Symmetrical genu varum before the age of two years is rarely pathological. Some degree of genu valgum is seen until the adult tibiofemoral angle of about 6° is reached at six to seven years of age. Genu varum is more likely to be pathological if it is: present after two years of age; unilateral; associated with shortening; severe; and in a child with obesity. Internal tibial torsion or an angular deformity arising from the tibial shaft or distal metaphysis may mimic genu varum. Both these conditions produce a widening of the intercondylar distance at the knee simply to facilitate each foot clearing the other when standing straight or walking. The follow-on from diagnosing a pathological genu varum is deciding whether progression of the deformity is likely. Gradual correction by external fixation (the Ilizarov method) is suitable if the genu varum is associated with tibial shortening.
