What is Adult-Onset Bow Leggedness?
Bow leggedness, known medically as genu varum, is a condition where the legs curve outwards at the knees, causing a noticeable gap when standing with the feet and ankles together. While this is a normal part of skeletal development in infants and toddlers, it is considered a clinical concern if it persists into later childhood or appears for the first time in adulthood. When a person asks, "Can you get a bow legged with age?", they are referring to this adult-acquired form of genu varum, which is quite different from its pediatric counterpart.
Congenital vs. Acquired Genu Varum: A Comparison
| Feature | Congenital (Childhood) Genu Varum | Acquired (Adult-Onset) Genu Varum |
|---|---|---|
| Onset | Present at birth or early childhood | Develops later in life, during adulthood |
| Cause | Fetal positioning in the womb (physiologic bowing), or underlying conditions like Blount's disease or rickets | Degenerative conditions like osteoarthritis, metabolic disorders, or unhealed fractures |
| Progression | Typically self-corrects by age 2-4 | Worsens over time if the underlying cause is not addressed |
| Symptoms | Usually asymptomatic in young children | Often accompanied by knee pain, instability, and gait changes |
The Causes of Acquired Bow Leggedness in Adults
Several medical conditions and factors can lead to the development of bow leggedness in adults. The key distinction from childhood bowing is that it's almost always a sign of a deeper issue, not a normal part of development.
Osteoarthritis
Osteoarthritis (OA) is the most common cause of adult-onset genu varum. This "wear-and-tear" arthritis involves the breakdown of cartilage that cushions the joints. In the case of genu varum, the cartilage on the inner (medial) side of the knee is often affected disproportionately. As this cartilage erodes, the joint space narrows unevenly, causing the leg to push outward and bow. This uneven stress accelerates further joint damage, creating a painful cycle.
Paget's Disease of Bone
This metabolic disease disrupts the body's natural process of bone remodeling, where old bone tissue is replaced with new. In Paget's disease, the process becomes disordered, leading to the formation of new, weaker bone tissue that is more prone to fracture and deformity. This can cause the bones in the legs, such as the tibia and femur, to weaken and bow over time. It is a condition that is more prevalent in older adults.
Adult Rickets (Osteomalacia)
Adult rickets, or osteomalacia, is the adult form of the childhood disease. It is caused by a severe and prolonged deficiency of vitamin D and calcium, which are essential for healthy bone mineralization. This deficiency leads to soft, weak bones that can bend under the body's weight, causing the legs to bow.
Other Contributing Factors
- Mal-rotation of the Tibia: Sometimes, a twisting of the shin bone can contribute to a bow legged appearance. This can be subtle but places damaging shear stress on the knee joint.
- Obesity: Excess body weight puts significantly more stress on the knee joints, accelerating the progression of osteoarthritis and the associated bowing.
- Improperly Healed Fractures: A fracture to the leg bones, particularly around the knee, that does not heal correctly can result in a permanent misaligned bone structure, leading to a bowed appearance.
Associated Symptoms and Long-Term Complications
The development of bow leggedness in adulthood is often accompanied by a host of symptoms and can lead to significant complications if left untreated.
Common Symptoms:
- Knee Pain: A primary symptom, often localized to the inside of the knee due to increased pressure on the medial compartment.
- Joint Instability: A feeling that the knee is giving way or is unstable, particularly when bearing weight.
- Gait Changes: An altered walking pattern (gait) or noticeable limp.
- Pain in Other Joints: The misalignment can affect the hips and ankles as the body tries to compensate, leading to pain in these areas as well.
- Reduced Range of Motion: Stiffness and decreased flexibility in the knee.
Long-Term Complications:
Untreated genu varum can lead to severe and chronic problems. The uneven stress on the knee joint can lead to progressive and debilitating arthritis. In severe cases, the constant wear and tear may necessitate knee replacement surgery, often at a younger age than typical for the procedure.
Diagnosis and Treatment of Adult Genu Varum
Diagnosis
An orthopedic specialist will typically perform a physical examination and take a medical history. To determine the exact cause and severity of the bowing, imaging tests may be ordered, such as X-rays or an MRI. These can reveal the extent of cartilage loss, bone deformity, and joint misalignment.
Treatment Options
Treatment for adult-onset genu varum depends on the underlying cause and severity. Options range from conservative management to surgical intervention.
Non-Surgical Management:
- Physical Therapy: Strengthening the muscles around the knee, particularly the hip abductors and adductors, can help improve balance, reduce pain, and slow progression. A physical therapist can create a customized plan.
- Orthotics and Braces: Custom shoe inserts or knee braces can help redistribute pressure on the knee joint, providing support and relieving pain.
- Weight Management: Losing excess weight significantly reduces the mechanical stress on the knees, which can slow the progression of osteoarthritis.
- Medication: Anti-inflammatory drugs can help manage pain and swelling associated with arthritis.
Surgical Correction:
For more severe cases, or when conservative treatments fail, surgery may be the best option to correct the alignment and save the knee joint.
- Osteotomy: This is a common procedure where the orthopedic surgeon cuts and reshapes the tibia (shin bone) or femur (thigh bone) to realign the leg. This can shift the weight-bearing load to the healthier side of the knee joint, reducing pain and preventing further damage.
- Knee Replacement: In cases where arthritis is advanced, a partial or total knee replacement may be necessary to alleviate pain and restore function.
Preventing Worsening of the Condition
While some conditions are not fully preventable, you can take steps to manage your bone health and mitigate risk factors:
- Maintain a Healthy Weight: This is one of the most effective ways to reduce joint stress.
- Ensure Adequate Vitamin D and Calcium: For adult rickets, a balanced diet or supplements can correct the deficiency and strengthen bones.
- Engage in Low-Impact Exercise: Activities like swimming, cycling, and yoga can strengthen muscles without putting undue pressure on the knees.
- Practice Proper Lifting Techniques: Protect your knee joints from injury by using correct form when lifting heavy objects.
For more detailed information on orthopedic procedures for adults with genu varum, consult a qualified specialist. The Hospital for Special Surgery provides comprehensive resources on surgical options.
Conclusion: Seeking Expert Guidance for Adult Bow Leggedness
The question of "can you get a bow legged with age" has a clear answer: yes, it can happen, and it is most often a symptom of an underlying medical condition. Unlike the physiological bowing of childhood that resolves naturally, adult genu varum warrants careful medical evaluation. Conditions like osteoarthritis, Paget's disease, and osteomalacia must be accurately diagnosed to determine the most effective treatment plan. Whether through non-surgical management like physical therapy and weight control, or corrective surgery such as an osteotomy, addressing the issue can help manage pain, prevent further joint damage, and improve overall mobility and quality of life.
How to Manage and Potentially Prevent Worsening Conditions
Lifestyle Adjustments for Joint Health
For individuals with, or at risk of, developing genu varum, certain lifestyle changes can be beneficial in managing symptoms and slowing progression.
- Stay Active with Low-Impact Exercise: Avoid high-impact activities that put excessive stress on the knees, such as running. Instead, opt for cycling, swimming, rowing, and walking on flat surfaces.
- Consider Physical Therapy: A physical therapist can provide targeted exercises to strengthen the hip and leg muscles, which can help support the knee joint and improve alignment.
- Use Proper Footwear: Wearing supportive shoes and, if recommended, custom orthotics can help correct foot mechanics and reduce strain on the knees.
- Maintain a Healthy Weight: Losing even a small amount of weight can have a significant positive effect on knee pain and slow joint degeneration.
- Supplement Nutrients: If nutritional deficiencies are the cause, such as vitamin D and calcium insufficiency, supplements or dietary changes can address the root problem.
It is always best to consult a healthcare professional before starting any new exercise routine or treatment plan, especially if you are experiencing knee pain. They can help you develop a safe and effective strategy for your specific condition.
