​What kinds of symptoms do patients experience before receiving treatment?

Genu varum, commonly known as bowleg, is marked by knees being apart when the patient is standing with feet together. While common in infants up to age 2-3 years, genu varum that persists beyond this point may require treatment. The most apparent symptom is an altered walking pattern. Bowleg can also cause discomfort in hip, knees, and ankles from the stress of the bowed leg.

​What is the impact on patients’ lives of living with these conditions?

Bowlegs range in severity and can be functional though uncomfortable. The early and abnormal stress from untreated genu varum in adulthood is associated with accelerated onset of arthritis and increased risk of medial meniscus tears.

What cultural or regional factors affect the treatment of these conditions?

Genu varum can be caused both by genetics and by vitamin and mineral deficiencies. In particular, rickets is a major cause of bone disease in children, resulting from insufficient calcium, phosphorus, and vitamin D. Cambodia has high rates of malnutrition and essential vitamin deficiencies, which contribute to the risk of bowleg. In addition, treatment may not often be sought early, and with genu varum, early action may prevent the need for more invasive surgery in adolescents and adults.

What does the treatment process look like?

The goal of surgical treatment for genu varum is to realign the legs. Depending on the age of the patient, treatment is generally either by guided growth or osteotomy. Guided growth (temporary hemiepiphysiodesis) is less invasive, and able to be performed on patients whose bones are still growing (around 14-16 years old). Under this procedure, a plate is inserted onto the lateral side of the growth plate of the bone, which guides the growth of the bones. Guided growth can also be done by stapling, which creates asymmetrical growth by compressing the physis. In patients who cannot have this surgery, an osteotomy is performed whereby the tibia is cut below the knee and a wedge-shaped graft is inserted to shift the pressure to the outside of the knee. Patients then need to protect and support the leg with a brace.

What is the impact of this treatment on the patient’s life?

Treating genu varum relieves the patient of any discomfort that may have been caused by the abnormal stress on knee and ankle joints, and reduces risk of early arthritis. Patients also no longer have the visual appearance of bowlegs.

What potential side effects or risks come with this treatment?

Risks of a knee osteotomy include infection in the bone, failure of the graft to take, and injuries to surrounding nerves or blood vessels. Guided growth has fewer risks than osteotomy. However, patients undergoing guided growth need to be regularly checked, as the plates need to be removed at a specific time period to prevent overcorrection.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

Surgical treatment in Cambodia can be expensive and hard to access. Patients will travel for hours by car, motocycle, and bus to receive free surgery at CSC.

What are the alternatives to this treatment?

While braces and specially designed shoes exist as alternatives to surgery in growing children, these options are not well supported by the medical literature and may cause growth problems.