Do you become more bow-legged as you age? Understanding the causes of adult genu varum

According to the Arthritis Foundation, maintaining a healthy weight is one of the most important ways to protect your knees and other joints as you age. So, do you become more bow-legged as you age? The answer is complex; while not a universal consequence of getting older, certain medical conditions can lead to a progressive bowing of the legs in adulthood.

Quick Summary

The development or worsening of bow-leggedness in adults is not an inherent part of the aging process but often points to underlying medical conditions such as advancing osteoarthritis or Paget's disease, requiring proper diagnosis and management.

Key Points

• Age and Bow-Leggedness: The progressive development of bow-leggedness in adults is not a normal part of aging but a symptom of an underlying medical condition, such as advanced arthritis.

• Primary Cause is Osteoarthritis: Uneven cartilage wear in the knee, especially in the inner compartment, is the most common reason for a bowing deformity in older adults.

• Other Causes Exist: Paget's disease, severe vitamin D deficiency, and improperly healed fractures are other potential causes for adult genu varum.

• Watch for Symptoms: Beyond the visible curvature, look for persistent knee pain, altered gait, and balance issues, which signal a need for medical attention.

• Management is Key: Non-surgical strategies like weight management, physical therapy, and orthotics can help manage symptoms and slow progression, while surgery is an option for severe cases.

Is Adult Bow-Leggedness a Normal Part of Aging?

While infants are often born with physiological bowing that naturally corrects itself, the onset or progression of bow-leggedness (genu varum) in adulthood is a different matter. In adults, this curvature is not a normal sign of aging but is usually a symptom of an underlying health condition that affects bone and joint structure. The visible change in leg alignment is a physical manifestation of a deeper issue, most often related to a breakdown of the knee joint.

The Link Between Osteoarthritis and Bowing Legs

Osteoarthritis (OA) is the most common culprit behind adult-onset genu varum. As the "wear-and-tear" arthritis progresses, the cartilage that cushions the knee joint begins to deteriorate. For many individuals, this breakdown is not uniform. The medial (inner) compartment of the knee is often affected first, and more severely, than the lateral (outer) compartment.

This uneven cartilage wear has a profound effect on leg alignment. The loss of cushioning on the inner side of the knee causes the joint space to narrow, forcing the leg to bow outward under the body's weight. This shift in alignment creates a vicious cycle: the bowing increases the load on the already damaged inner knee, accelerating the cartilage loss and causing the deformity to worsen over time.

Other Medical Causes for Adult Bow-Leggedness

Beyond osteoarthritis, several other conditions can contribute to bowing legs in older adults:

• Paget's Disease: This metabolic disease disrupts the body's normal bone rebuilding process, causing newly formed bone to be weaker and more misshapen. When Paget's disease affects the long bones of the legs, it can lead to bowing and increased fracture risk.
• Adult Rickets (Osteomalacia): Caused by a severe vitamin D deficiency, this condition softens the bones, making them susceptible to bowing under the strain of bearing weight.
• Previous Injuries: An old fracture in the leg that healed improperly or an injury to a growth plate can cause long-term alignment issues that become more pronounced with age.
• Blount's Disease: While typically diagnosed in childhood, an adolescent form of Blount's disease can manifest later and, if untreated, continue into adulthood, especially in individuals who are overweight.

Signs and Symptoms to Watch For

If you are concerned about developing bow-leggedness, or a progressive worsening, it's important to be aware of the signs. While the outward curvature of the knees is the most visible symptom, other indicators suggest an underlying joint problem:

• Persistent knee pain, particularly on the inner side of the joint.
• An uneven or altered walking pattern (gait).
• Hip or back pain, which can develop as the body tries to compensate for the altered biomechanics.
• A sensation of instability or giving way in the knees.
• Difficulty with balance and coordination.

Comparison: Infant Physiological Bowing vs. Adult Genu Varum

Feature	Infant Physiological Bowing	Adult Genu Varum (Pathological)
Cause	Normal skeletal development and position in the womb	Underlying medical condition (e.g., osteoarthritis, Paget's disease)
Onset	Present at birth, corrects by age 3-4	Develops or worsens later in life
Progression	Naturally improves over time, no intervention needed in most cases	Tends to worsen over time if untreated, accelerating joint damage
Symptoms	Typically asymptomatic; no pain	Often causes pain, instability, and functional limitations
Treatment	Observation; rarely needs intervention	Varies based on cause; includes non-surgical management and surgery

Management and Treatment Options

Addressing adult genu varum starts with identifying and treating the root cause. A consultation with an orthopedic specialist is the first step toward a proper diagnosis. Depending on the severity and cause, treatment may include:

1. Weight Management: Reducing excess weight significantly decreases the load on the knee joints, slowing the progression of arthritis and bowing.
2. Physical Therapy: Targeted exercises can strengthen the muscles around the knees and hips, improving stability and gait.
3. Orthotics: Custom shoe inserts can help correct imbalances in gait, redistributing pressure on the knee joint.
4. Medications: Anti-inflammatory drugs can help manage pain and inflammation associated with arthritis.
5. Surgical Intervention: For severe cases, surgery may be the most effective option. A procedure called an osteotomy involves reshaping the leg bones to realign the knee joint and correct the deformity, potentially delaying or preventing the need for a total knee replacement.

For more in-depth medical information on bowlegs, you can visit the MedlinePlus Medical Encyclopedia.

Conclusion

While a mild increase in bowing can be a part of the natural changes in posture and joint alignment that occur with aging, a noticeable or worsening bow-legged appearance is not typical. It is a strong indicator of an underlying medical issue, most frequently arthritis, that should be evaluated by a healthcare professional. By managing the underlying condition, maintaining a healthy weight, and staying active with low-impact exercises, older adults can effectively manage symptoms and slow the progression of genu varum, helping to preserve joint health and mobility for years to come.

Frequently Asked Questions

Can I develop bow-leggedness in my 50s or 60s?

Yes, while not normal, it is possible for bow-leggedness to develop in your 50s or 60s. It is typically caused by conditions like osteoarthritis, where the cartilage in your knee wears away unevenly over time, causing the leg to bow outward.

Is it true that all babies are bow-legged?

Yes, most babies are born with a degree of bow-leggedness, which is considered physiological bowing. This is a normal part of skeletal development and almost always corrects itself naturally by age three or four.

Does being bow-legged cause pain?

Not necessarily in children, but in adults, bow-leggedness can cause significant pain, particularly on the inner side of the knee. This is due to the increased stress placed on the joint's cartilage, which can accelerate arthritis.

Can exercise fix bow-leggedness in adults?

Exercise cannot change the shape of the bone, so it won't fully correct the bowing in adults. However, strengthening the muscles around the hips and knees can improve stability, manage symptoms, and slow the progression of joint degeneration.

What is the medical term for being bow-legged?

The medical term for being bow-legged is 'genu varum.' It is a condition where the legs curve outward at the knee, causing a gap between the knees when standing with feet and ankles together.

Can vitamin deficiency cause bow-leggedness in adults?

Yes, a severe, long-term deficiency of vitamin D can lead to a condition called osteomalacia (adult rickets), which softens the bones and can cause a bow-legged deformity over time. Proper nutrition is crucial for bone health.

When should I see a doctor for bow-leggedness?

You should see a doctor if you notice a progressive worsening of the curvature, experience persistent knee or joint pain, or if you have difficulty walking or balancing. Early intervention can help manage the underlying cause and prevent further complications.