Guided growth procedures are a surgical treatment option for the management of pathologic genu valgum deformity. Pathologic etiologies for genu valgum include idiopathic or secondary infection, trauma, tumor, or metabolic disease. Excessive valgus deformity in children may lead to poor knee and ankle mechanics, which may result in pain that is not responsive to physical therapy; patellar subluxation/dislocation; recurrent ankle sprain; osteochondral lesions; chondromalacia; pain with exercise; poor gait mechanics; joint instability; poorer quality of life/mental health burden; and long-term implications on skeletal health, including arthritis. Various surgical treatment options, including permanent epiphysiodesis, osteotomy, and hemiepiphysiodesis, are reviewed. The case presentation of an adolescent with idiopathic genu valgum is discussed, including the surgical technique for hemiepiphysiodesis of the bilateral distal medial femora and bilateral distal medial tibia. A retrospective review of patients who have undergone this procedure is discussed, including postoperative protocols and preoperative/postoperative scanogram measurements. The literature is reviewed, and pearls are discussed.