Varus knee: what is it and how is it treated?

By Cristiano Antonino On May 8, 2023

Varus knee is a deformity of the lower limbs. Also known as ‘bracketed knees’, ‘bowed knees’ and ‘O-knees’, due to the position of the knees that tend to ‘point’ in the opposite direction, varus knee is characterised by a misalignment between the tibia and the femur, causing the formation of an obtuse and internally (medially) open angle rather than a flat angle

Varus knee: causes

There are many causes of this condition.

These include rickets, diseases of bone metabolism (e.g. Paget’s disease), Blout’s disease (known as tibia vara) or neurological problems.

Possible causes of the disease are also repetitive knee ligament injuries that have been poorly treated or poorly consolidated fractures of the tibia and femur, or bone infections that have led to an altered development of the skeleton.

Varus knee in children

The varus knee is a fairly common deformity in children under the age of 18 months; it is a temporary problem that tends to disappear when the child starts walking.

In fact, the change in body weight load that occurs during the onset of walking usually corrects the deformity spontaneously.

In some cases, however, it can happen that this correction does not take place and that the problem even worsens; in this case, it is necessary to suspect the presence of other concomitant diseases such as rickets.

Rickets is a skeletal disease with infantile onset, characterised by a defect in the mineralisation of the bone matrix; it is very common in developing countries where poor hygienic conditions, prolonged vomiting and diarrhoea, and malnutrition lead to deficits in calcium, magnesium, phosphorus and many other elements necessary for bone growth.

Patients are predisposed to fractures and bone deformities.

Varus Knee in Football Players

Football players have a higher frequency of a varus knee, especially if they have been playing the sport since adolescence.

In fact, it seems that the type of activity they engage in causes an imbalance between the inner and outer muscles of the thigh, thus predisposing them to varus and a loss of alignment between the femur and tibia.

Varus knee: symptoms

Varus knee, in its mildest forms, usually presents no particular symptoms and is only a cosmetic problem.

In cases of severe varus knee, however, symptoms such as bone or muscle pain, knee instability, reduced mobility and gait disturbances may occur.

In such cases, complications at the meniscal or ligamentous level may occur.

Varus knee: complications

Varus knee is associated with various complications.

One of the most serious is a rupture of the meniscus or one of the knee ligaments.

The overloading of the medial meniscus, in fact, if not adequately treated can evolve into the rupture of the meniscus itself.

Furthermore, the suffering of the cartilaginous tissue lining the bony ends of the knee resulting from this condition can evolve into arthrosis, even early arthrosis.

Varus knee: Diagnosis

The diagnosis is generally made by the orthopaedist during a specialist examination with a simple objective test.

The doctor notes the divergent course of the femurs from the hip and a degree of contact of the ankles that is higher than normal anatomy.

Further investigations such as, for example, MRI scans and blood tests may then be prescribed to supplement this.

Varus knee: therapy

In cases of asymptomatic subjects or patients with mild varus knee, treatments, especially invasive ones, are not considered indicated.

Therefore, symptomatic patients with reduced quality of life due to the disorder or severe deformity are the ones to be treated.

The options are varied and range from conservative treatment to surgery.

The effectiveness of conservative treatment depends on many factors and is also related to the severity of the condition.

It involves the use of aids such as orthopaedic insoles and shoes, and physiotherapy exercises to strengthen the thigh muscles that play a key role in promoting alignment between the femur and tibia.

The physiotherapist will also help the patient to strengthen the elasticity of the knee ligaments.

Postural gymnastics can also help.

Weight loss in the case of overweight or obese patients is recommended.

If the patient complains of pain, the administration of anti-inflammatory drugs may be considered.

Surgery, generally reserved for the most severe cases (symptomatic patients or those with meniscus complications), usually consists of an osteotomy operation.

This is a very delicate operation, with a generally favourable prognosis, to correct the axis of the knee.

Varus knee: the difference with valgus knee

Not to be confused with varus knee, valgus knee is another type of knee deformity; in this case, the knees ‘point’ towards each other.

Not only are the femurs and tibiae not aligned, but the femurs tend to converge with each other and the tibiae tend to move apart; we therefore tend to speak of ‘X-knees’.

Causes of valgus knee include metabolic bone diseases, poorly established bone traumas, overweight and infection, but also alterations in the thigh muscles.

As in the case of varus knees, patients with valgus knees are generally asymptomatic and have no impairment of their quality of life.

In the more severe forms, however, subjects may complain of pain and manifest complications mainly affecting the lateral meniscus and knee ligaments.

Generally, degeneration into arthrosis of the external compartment of the knee occurs later than in the varus knee.

Even in this case, an orthopaedic examination is sufficient to make a diagnosis even quickly.

In this case, the femur and tibia objectively form an obtuse angle outwards and the malleoli are widely spaced.

Only in cases of high severity or impairment of the patient’s quality of life can surgery be considered indicated.

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