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Bow Leg Surgery

Bow Leg Surgery in India|HealthcaretripIndia

Bow Leg Surgery

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Osteotomy is a common well-established correction surgery performed to correct bow legs. 


Genu varum, as bow legs are referred to, in medical terminology, is a common condition characterized by bow shaped legs, curved outwards and widely spaced knees, even when feet are placed together. It is a limb deformity which can be corrected with surgery.


Bow legs are caused due to an underlying medical condition such as rickets, paget's disease, blount's disease amongst others. Presence of bow legs even after 2 years of birth is abnormal. If left untreated, may lead to arthritis of the knee or hip. 


Majority of people with Genu Varum or bow legs resulting from some pathology or disease, do not respond to non surgical treatment and therefore often require surgery. 


If one has bow legs on both sides, the bow leg surgery for each leg is done at different times, preferably at a gap of 2 to 3 months at least.


HealthcaretripIndia is associated with the best bone and joint hospitals of India that take pride in the most advanced infrastructure, state of the art facilities and top orthopedic surgeons who are experts in their own field. 


If you are seeking bow leg correction surgery, High Tibial Osteotomy, from top orthopedic surgeons at world class hospitals of India, you need to scan and send us your medical reports at or


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Q1 What are bow legs?


A1 A type of deformity of legs characterized by outwardly curved bow shaped legs and wide apart knees, even when feet and ankles are positioned together. In medical terminology, it is also known as Genu Varum. It is a common condition in infants and toddlers, however, occasionally can be seen in adolescents also, who are remarkably obese.


Q2 What are the causes of bow legs?


A2 Bow legs are caused by the following:


  • Physiological bow legs Physiological Genu Varum:
    • ​Normal
    • Seen in children under 2 yrs of age
    • Just a normal variation in the appearance of legs.
    • Bowing of legs in this case gets to normal with time. The improvement usually starts at a slow pace but progressively around the age of 18 month and by the age of 3 to 4 yrs the condition is rectified.
  • Blount's disease:

    • May be present in both toddlers and adolescents.

    • Cause: Abnormal growth plate in upper part of Tibia (Shin bone). It is also known as Tibia Vara. Growth plates are present at the ends of a child's long bones. They are responsible for the length and shape of the adult bones.

    • Impossible to differentiate it from Physiological (normal occurring) Genu Varum (bow legs) in children less than 2 yrs of age. However, unlike physiological bowing of legs, bow legs due to Blount's disease will deteriorate over time. As a result, when the child approaches 3 yrs of age, it could be identified well on      X- rays.

  • Rickets:

    • Softening and weakening of bones of children

    • ​Due to Nutritional Deficiency of Vitamin D.

    • It could be Genetic as well which leads to poor Vitamin D absorption.

  • Paget's disease

    • It is a metabolic disease

    • ​Under normal conditions, new bone tissue replaces the old bone tissue. However, in case of Paget's disease, this recycling mechanism of the bone tissue is disturbed leading to fragile or bent bone.

  • Dwarfism: Achondroplasia, a bone growth disorder, the most common type of dwarfism that eventually results in appearance of bow legs.

  • Bone fracture with improper healing

  • Bone dysplasia, with faulty development of bones

  • Fluoride Poisoning

  • Lead Poisoning

​Q3 How can one identify or diagnose bow legs?


A3 It is very easy to recognize bow legs. When feet are placed together, knees appear to be positioned wide apart and legs appear to be bow shaped outwardly. Most of the time, bow legs condition starts to improve when the baby turns 12 to 18 months of age.

However, if the condition stays or worsen beyond 2 years of age in a child, you must see orthopedic surgeon for the best treatment option for the child. 

The orthopedic surgeon will be able to assess the severity of deformity, the underlying cause of the condition and the best treatment option for it.

After thorough clinical examination, your doctor is most probably going to assure you and ask you to wait and watch in case of presence of symmetrical bow legs in an otherwise healthy child below 2 yrs of age. 

In case he feels that there is asymmetrical bowing of legs, he may prescribe an X ray of the lower legs of the child in a standing position.  Your doctor may order some blood tests or other imaging tests to look for the underlying disease. He may take your leg measuments and observe your walk.


Q4 What are the signs and symptoms of bow legs?


A4 Unusual walking pattern and also, leg appearance. However, it does not impact the ability of the child to crawl, walk or run.


It does not usually causes pain or discomfort. However, persistent and worsening bow shaped legs do put stress on the joints such as hip, knee and ankle thereby causing discomfort eventually.


At times, when the bow legs are coupled with intoeing or Pigeon toes (inward pointing toes), it may lead to frequent tripping of the child which normalizes with passing time.


Q5 What is the treatment for bow legs?


A5 In infants and toddlers younger than 2 yrs of age, no treatment is usually required.


Treatment for them is indicated only if some underlying medical condition is identified. Severity of the bow legs and its progress over time also determine its treatment option. Treatment of the underlying medical condition responsible for bow legs, is given.


Braces, cast or corrective surgery are the various options and the best treatment option for the patient is determined by the specialist.


Q6 Can bow legs be prevented?


A6 Not exactly. However, you may prevent certain medical conditions that are responsible for occurrence of bow legs such as Rickets. Adequate intake of Vit D will prevent occurrence of rickets and thereby bow legs.

If you child has bow legs beyond the age of 2years, please do consult the orthopedic specialist.


Q7 What is the success rate of bow legs correction surgery?


A7 98-99% is the success rate of the bow leg correction surgery. 


Q8 Who is an eligible candidate for bow leg surgery?


A8 Your orthopedic surgeon will determine if you are going to benefit from the surgery or need it in the first place. They usually take into consideration the intensity of the deformity and evaluate each patient thoroughly.

The most important indications for the osteotomy surgery for correcting bow legs are:

  • If the deformity is severe, causing symptoms such as abnormal gait, aesthetically in bad shape and causing osteoarthritis.

  • Progressively worsening and not responding to conservative (non surgical) treatment


Q9 What are the objectives of osteotomy surgery?


A9 To correct the angular deformity and realign the axis of the lower limb, femur and Tibia.


Q10 What is Osteotomy surgery?


A10 Osteotomy(Osteo-bone + tomy-cut= bone cutting) is a surgery that is characterized by cutting of bone.

The purpose of cutting of bone may be to lengthen the bone, shorten the bone or proper alignment of the bone.


Q11 How long does the osteotomy surgery take?


A11 It takes around 1.5 to 2 hours. It may vary from patient to patient, though.


Q12 What is the recovery time after osteotomy surgery?


A12 3 to 6 months are needed to walk normally and achieve full range of motion. High impact activities may be done only after an year or so. Please consult your bone and joint specialist to know exactly what time you may require to resume high impact exercise or activity. 


Q13 How much is the duration of stay in India, after discharge from the hospital?


A13 2 to 3 weeks


Q14 How long is the hospital stay for bow leg sugery?


A14 Usually, 3 to 4 days


Q15 Who can undergo High Tibial Osteotomy(HTO) Surgery?


A15 The following criteria is usually adhered to, while deciding a suitable candidate fot High Tibial osteotomy surgery:

  • Young and active patient

  • Good vascular status

  • Daily activities are being compromised due to pain or other symptoms

  • Patient is not obese

  • Patientis otherwise fit for the surgery

  • Patient compliance to follow the after surgery protocol for favorable outcome is important.


Q16 What is High Tibial osteotomy Surgery for bow legs correction?


A16 HTO surgery involves cutting the tibia bone(surgical fracture) not completely, but only 3/4th across the bone, in top and medial/inner part of tibia which is just below the knee.


In that gap, a bone graft wedge(a piece of bone) is inserted and secured with screws and plates and the surgical wound is closed.


Your specialist will take precise measurements of the bones, the malalignment and even the size of the bone graft which needs to be inserted and align the bones correctly before securing them in place.


The bone graft is taken from another bone of the patient himself, usually it is the pelvic bone. This kind of the bone graft is referred to as an autograft.


Although there are other types of bone grafts as well, depending upon the source of bone such as allograft (bone graft taken from another person, usually taken from bone banks that preserves the bone harvest from cadavers) and artificial or synthetic bone grafts. 


The most commonly used is the bone graft from the patient himself as they facilitate bone growth and healing.


High Tibial Open Wedge Osteotomy, as explained earlier, wherein a piece of bone is inserted in the upper medial part of the shin bone and secured in place, ensures that the signs and symptoms of bow legs are relieved.



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Dr Ravi Sauhta

MBBS, MS(Orthopaedics)

Head - Orthopaedics & Chief - Joint Replacement & Arthroscopy

Artemis Hospital, Delhi-NCR, Gurgaon

Dr Manoj Padman

MBBS, MS (Orthopedics), DNB (Orthopedics), MSc Research (UK),

FRCS (Glasgow), FRCS (Trauma and Orthopedics)

Director, Pediatric Orthopedics

Madhukar Rainbow Children's Hospital, Delhi


Dr Nargesh Agarwal

MBBS, MS(Orthopedics), Fellow Pediatric Orthopedics, JPOA(Japan), COC

Consultant, Pediatric Orthopedics

BLK Super Speciality Hospital


Dr Ashok Rajgopal

MBBS,MS (Orthopedics),MCh (Orthopedics), FIMSA, FRCS

Group Chairman

Institute of Musculoskeletal Disorders and Orthopedics

Medanta Medicity, Delhi NCR, Gurgaon


Dr SKS Marya


Chairman, Bone and Joint Institute

Medanta Medicity, Delhi NCR, Gurgaon


Dr. Anil Raheja

MBBS, MS(Ortho), MCh(Ortho)

Senior Consultant -  Orthopaedics  

Apollo Spectra Hospitals

New Delhi

Dr Bhushan Nariani


Director, Joint Replacement

BLK Super Specialty Hospital, New Delhi

Dr Ratnav Ratan

MBBS, MS, DNB (Ortho), Dip. SICOT

Fellowship in Pediatric Orthopedics, Mumbai

Senior Consultant, Pediatric Orthopedics

Manipal Hospitals, Gurugram, Delhi-NCR

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