Ask the Expert: Why Should I Correct My Bowlegs?

In this week’s installment of Ask the Expert, Orthopedic Surgeon Dr. Austin Fragomen explains the importance of correcting bowlegs.?

Bowleg, or Genu Varum, is a common condition encountered worldwide.

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People often complain of knee or ankle discomfort as a result of this limb deformity and worry about the development of future arthritis. Some people are bothered by the sight of their own legs and do not even realize the danger that lies ahead for many of them.

  • Damage may be occurring to your knee: With bowing, the knee experiences unbalanced loads that it was not designed to handle. This leads to excessive stress and tearing of the medial meniscus and articular cartilage and can cause IT (iliotibial) band pain. In the joint the cartilage fissures and delaminates until bone starts rubbing against bone. Several factors accelerate the decline of the knee joint: obesity, a family history of arthritis, and high physical activity. In other words, both overweight and fit people with bowlegs are at risk!
  • Abnormal foot rotation torques the knee: Many folks who have bowlegs also have mal-rotation, or torsion, of the tibia. This means that either the feet turn inward or outward compared to the knees. In a recent review of patients that have come to our institute for bow leg correction half have had rotational malalignment. The torsion may be obvious.

Bowlegs 2

However, many times the rotational component is subtle. For example, patients with external tibial torsion will walk with the feet straight and the knees squinting inward.

Bowlegs 3

This is most obvious when these people run and their feet and legs look like a helicopter. They have difficulty riding a bicycle as the knees knock against the bike frame. This torsion twists the knee joint (and the ankle joint), causing shear injury to the meniscus and joint cartilage.

  • Restoring proper bone structure will improve function: Proper limb alignment affects the entire body in a positive way. The muscles and tendons are pulling along their intended trajectory, optimizing their efficiency. The ligaments, which hold the joints together, no longer experience undue stress. Anecdotally, high performance athletes who came to me with bowleg-related knee pain were able to return to sports at a higher level of function and performance after surgery. The best results can be expected in cases where the knee is not already burdened with arthritis.
  • Correcting bowlegs may avert future surgery: Many people with bowlegs have knee replacement surgery in their future. Although knee replacement provides a good result, it is certainly not as valuable as the native knee. Osteotomy surgery to correct the bow may be the antidote to avoid knee replacement.
  • Osteotomy will correct bowlegs: The belief that bowlegs can be corrected without surgery is a fallacy. Varus deformity around the knee is a structural deviation from normal bone alignment.

Bowlegs 4

Exercise, stretching, strengthening, physical therapy, and vitamins will make your muscles and bones stronger but will not change the shape of the bones. The only way to truly change the shape of the legs is to break the bone and straighten it.

Bowlegs 5

This is an enduring, structural alteration.

Dr. Austin Fragomen is an orthopedic surgeon and the fellowship director of the Limb Lengthening and Complex Reconstruction Service at Hospital for Special Surgery. Skilled in the art of less invasive surgery, Dr. Fragomen performs a sophisticated and comprehensive analysis of each patient to determine an optimal treatment plan. Whether performing an all-arthroscopic rotator cuff repair or re-aligning a deformed limb through mini-incisions, the goal remains the same: to minimize the trauma of surgery and maximize a rapid and functional recovery.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


  1. Our son, age 4 and turning 5 in June 2016, was diagnosed w/bi-lateral infantile Blount’s Disease at age 1 and KAFO braced with overall great success in the right leg. The brace design halted progress of the disease in the left, but did little to reverse deformity. A new modified KAFO was late coming, but allowed for measurable improvement, back to within 4 degrees of normalcy w/continued improvement being shown. Despite this his pediatric orthopedic has insisted upon surgery, based upon recurrence stats for age. We countered that there is clinical support to show the disease is inactive in both physes, and since active correction is still being shown, requested data to support the recommendation for surgery, not for correction but from fear of future reversal of correction made. P.O. based decision solely upon fear of future recurrence without a determination of the current status of the disease. We’ve documented a physiological healing of the physes, and there has been NO active deformation to the tibia in 3 years. I realize an 88% “recurrence” rate for age 4+, but I also know those stats are post-operative and the high rate of additional deformity was in kids with an active status of Blount’s at the time of surgery. We contend we have a dormant/healed status of the disease, with active correction, thus the stats fail to account for a sufficient SOLE reasoning for surgery. Keep in mind, no problems in walking, no pain, no discomfort, no limitation in movement. Unusual case, now nearly 4 years in KAFO. How does one counter the stats that don’t really apply to each and every case? What truly is the argument for surgery?

    1. Hi Gary, thank you for your questions. Dr. John Blanco, pediatric orthopedic surgeon, says: “Bracing is generally not used in children older than 3 years. If Blount’s isn’t corrected by age 4 with braces, it would usually require surgery. It’s recommended to schedule an appointment with a physician as an x-ray would answer the question of the need for surgery.”

    1. Hi Mirek, thank you for reaching out. We have an outpatient facility in Stamford where you can be seen for office visits, pre-surgical screening and follow up appointments. Surgeries are performed at our main campus in New York City. For more information on our Stamford Outpatient Center, click here: If you would like to seek consultation with a physician based in our Stamford office, please contact our Physician Referral Service at 877-606-1555 for further assistance. The Physician Referral Service will assist in ensuring that patients are connected with the physician that best meets their needs. For more information, visit

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