GENU VALGUM

Genu valgum( "knock-knee")
  • It is a condition in which the knees angle in and touch one another when the legs are straightened.
  • The term originates from the Latin genu, "knee", and valgus which actually means bent outwards, but in this case, it is used to describe the distal portion of the knee joint which bends outwards and thus the proximal portion seems to be bent inwards.
Pathophysiology:
  • In genu valgum, as the mechanical axis shifts laterally, pathologic stress is placed on the lateral femur and tibia, inhibiting growth .
  • According to the Hueter-Volkmann principle, continuous or excessive compressive forces on the epiphysis have an inhibitory effect on growth. 
  • Consequently, growth in the lateral condyle of the femur is suppressed globally, resulting in a shallow femoral sulcus and a propensity for the patella to tilt and subluxate laterally. 
  • Persons with knock knees often have collapsed inner arches of their feet, and their inner ankle bones are generally lower than their outer ankle bones. Adults with uncorrected genu valgum are typically prone to injury and chronic knee problems such as chondromalacia and osteoarthritis. 
Etiology:
  • Toddlers aged 2-6 years may have physiologic genu valgum. For this age group, typical features include ligamentous laxity, symmetry, and lack of pain or functional limitations. In contrast, adolescent idiopathic genu valgum is not benign or self-limiting. 
  • Teenagers may present with a circumduction gait, anterior knee pain, and, occasionally, patellofemoral instability.
  • Various other conditions, including postaxial limb deficiencies, genetic disorders such as Down syndrome, hereditary multiple exostoses, neurofibromatosis, and vitamin D–resistant rickets ,Marfan syndrome, osteogenesis imperfecta and rheumatologic diseases may cause persistent and symptomatic genu valgum.
Treatment:
  • Physiologic genu valgum should be treated expectantly.
  • Bracing and therapy are inadequate to meet these goals.
  • Surgical intervention is the only successful intervention for correcting the problem. Surgical options include osteotomy or growth manipulation (hemiepiphysiodesis).
Exam Question
  • Genu valgus deformity seen when Long axis of tibia & fibula moves lateral to the long axis of femur
  • Pappu, 7 yrs old young boy, had fracture of lateral condyle of femur. He developed malunion as the fracture was not reduced anatomically. Malunion will produce Genu valgum Most common cause of genu valgum in children is Rickets
  • Genu valgum deformity is seen in Rickets, Bone Dysplasia & RA
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