Bow Legs

How do Children’s Legs and Knees Develop?

Bowlegs in infants: Bow-leggedness is normal between the ages of one and 24 months.

Toddlers: Toddlers’ legs align between the ages of 24 and 36 months.

Young children: Between the ages of 3 and 5, children may develop knock knees, a condition in which the knees bend inward.

Children’s legs continue to straighten as they grow. Around the ages of 7 to 8, or possibly closer to the adolescent years, children’s walking patterns usually become normal or almost normal.

Who gets Bow Legs?

Bow legs are typically seen in young children. Bow-legged newborns often outgrow the deformity around 18 months of age. Older kids may also have bow legs. To ensure that a more severe condition does not exist, we recommend parents bring their children to us for an examination.

What Causes Bowed Legs?

Bow legs can form for a variety of reasons. For instance, a condition known as physiologic genu varum is the most common cause of bow legs. Physiologic genu varum is simply your child’s normal developmental process. If your child’s legs haven’t straightened around the age of two, an underlying medical condition could cause the problem.  These are some examples that can cause bow legs.:

• Blount disease is a growth disorder caused by a problem in your child’s shin bone’s growth plate. Blount’s disease is more common in African American children, overweight children, and children who began walking at a young age.
• Rickets is a deficit in calcium or vitamin D is the root cause of this illness. Deficiencies in these essential nutrients soften and weaken your child’s bones, causing his or her legs to bow.
• The most commonly cited reason for dwarfism is achondroplasia. This condition can result in bow legs.
• Aberrant bone development and inadequately healed fractures (bone dysplasia) can cause bow legs.
• Lead or fluoride poisoning.
• Some inherited genetic bone disorder conditions can affect bone growth and leg alignment.

Symptoms of Bow-Legged Children

Bow legs, or genu varum, are a common condition in infants and toddlers. While mild bowing is often a normal part of development, persistent or worsening symptoms beyond age three may indicate an underlying issue. This guide provides a detailed look at the symptoms of bow legs in children under three and after three, helping parents recognize when to seek medical evaluation from a specialist.

Symptoms of Bow Legs in Children Below Three Years of Age

Bow legs are often a normal physiological condition in infants and young toddlers due to their natural fetal position in the womb. Most children outgrow this bowing as they begin to walk and develop stronger leg muscles. However, certain symptoms should still be monitored.

1. Visible Bowing of the Legs

• The most obvious symptom is an outward curvature of the legs, forming a noticeable “bow” shape when the child stands.
• The knees remain apart even when the feet and ankles touch.

2. Normal Movement Without Pain

• Children under three with physiological bowing usually show no signs of pain or discomfort.
• They can walk, crawl, and play normally without limping or showing distress.

3. Symmetrical Bowing

• In typical cases, both legs curve outward equally (symmetrical bowing).
• If one leg appears more bowed than the other, it may suggest an underlying bone condition rather than normal development.

4. Waddling Gait

• A wide-legged, waddling walk is common as toddlers learn to balance themselves.
• This gait should gradually improve as leg muscles strengthen.

5. No Impact on Growth or Activity

• Children with physiological bow legs continue to grow normally and remain active.
• Their ability to run, jump, and play is not affected by the bowing.

When Is It Normal?

• If the bowing is mild to moderate, symmetrical, and not causing pain or mobility issues, it is usually part of normal development.
• Most children’s legs naturally straighten between ages 18 months to 3 years as they grow.

Symptoms of Bow Legs in Children After Age Three

By age three, most children’s legs should begin to straighten. If bowing persists or worsens after this age, it may indicate an underlying condition requiring medical evaluation.

1. Bowed Legs That Continue or Worsen After Age Three

• The curvature of the legs should gradually straighten as the child grows.
• If the bowing remains unchanged or becomes more pronounced, it may suggest a skeletal or metabolic disorder.

2. Knees That Do Not Touch When Standing

• Even with feet and ankles together, the knees remain widely apart.
• This persistent gap may be a sign of abnormal bone development.

3. Uneven or Asymmetrical Bowing

• If one leg is significantly more curved than the other, it could indicate an underlying issue like Blount’s disease or a growth plate disorder.
• Uneven bowing can cause differences in leg length, leading to balance issues.

4. Reduced Range of Motion in Hips and Knees

• Difficulty fully straightening the knees when standing or sitting.
• Stiffness in the hip joints, affecting normal walking and running.

5. Knee or Hip Pain That Is Not Caused by an Injury

• Pain in the knees, hips, or ankles when walking or playing is abnormal and may indicate excess strain on the joints.
• Persistent or increasing discomfort should be evaluated by a doctor.

6. Limping or Difficulty Walking

• A child who develops a noticeable limp or has trouble keeping up with peers may have an underlying bone disorder.
• Limping that does not improve over time is a red flag for structural abnormalities.

7. Frequent Tripping or Falling

• If bowing interferes with balance and coordination, the child may trip often.
• This could indicate joint instability or leg length discrepancies.

8. Inward Rotation of the Feet (In-Toeing)

• The feet may turn inward when walking instead of pointing straight ahead.
• In-toeing can worsen balance and cause walking difficulties.

9. Delayed Motor Development

• If a child struggles with running, climbing stairs, or jumping, it may be due to weakened leg muscles or joint misalignment.
• Gross motor skills should improve with age, and persistent difficulties may need intervention.

10. Family History of Bone Disorders

• A history of conditions like rickets or Blount’s disease in the family may increase the risk of persistent bow legs.
• Parents should inform their doctor if there is a genetic predisposition to bone growth abnormalities.

When Should Parents Worry about Bow Legs?

If your child has bowlegs as well as any of the following symptoms, a more serious condition may exist.

• Bowlegs that get worse after the age of two.
• The bowing’s asymmetric appearance.
• Walking with a limp.
• Hip or knee pain.
• Petite stature (below the fifth percentile).
• When your infant is two years old and still has bow legs, call us for an appointment. We will perform a physical exam, look for underlying conditions, and recommend the best treatment.

When Should Parents See a Doctor?

If a child’s bow legs persist beyond age three, worsen over time, or are accompanied by pain, limping, or asymmetry, a pediatric orthopedic specialist should evaluate the condition. Early diagnosis and treatment can help prevent long-term complications.

Conclusion

While bow legs are common in young children, persistent or worsening symptoms after age three require medical attention. Parents should monitor for pain, asymmetry, or walking difficulties and seek evaluation if concerns arise. Early intervention can prevent future joint problems and improve a child’s mobility and overall quality of life.

Please contact us and make an appointment if your child exhibits any of the above symptoms.

How are Bow Legs Identified?

One of our specialists will perform a physical exam and inquire about his or her medical history. However, if your child is under the age of two, doctors normally will not request additional tests.  Rather, we will want to keep an eye on the bowing and ensure that it resolves on its own as your child grows. If your child is over the age of two, our doctors may measure his or her legs and observe him or her walking. We may order imaging tests like X-rays to look at the bones in your child’s legs and knees. To determine whether a disorder like rickets is the source of the bow legs, we may request blood testing. We are pediatric orthopedic specialists; so rest assured we know kids and you will get the very best of care for your child.

Can Doctors Correct Bow Legs?

Bow legs in infants and toddlers under the age of two usually go away on their own. As experts in this field, we will continue to monitor his or her condition. Depending on the cause of the condition, we treat older children and adolescents. Unless the condition is severe, babies and toddlers do not require treatment. After age two, if bow legs still exist, the underlying reason will dictate the appropriate course of action. braces, surgery, or treatment of the underlying condition may follow.

• Blount’s disease. Early intervention with a splint or leg brace may often solve the problem.
• Ricket’s disease. In coordination with your pediatrician, we may prescribe calcium and vitamin D supplements to help manage your child’s condition. If your child’s rickets is caused by a genetic condition, we may refer you to a specialist for treatment.

If the bowing persists despite treatment, the doctors may recommend surgery to prevent further damage and correct the problem. Among the surgical options are:

• Guided development. In this procedure, we will insert a small metal plate or staple into his or her leg. This will halt growth on the healthy side of the shin bone for a short time, allowing the unhealthy side to catch up. Your child’s leg will straighten with natural growth, and the plate or staple gets removed once alignment has improved.
• Tibia osteotomy. We will make an incision and reshapes the shin bone below the knee to fix the alignment. While the bone heals, it is held in place with a plate and screws inside the leg or an outside-the-leg frame.

How are Other Bowleg-Related Conditions Treated?

Blount’s disease is typically treated with a combination of non-surgical and surgical measures, including the use of a special brace. Doctors recommend that the brace, known as a modified knee-ankle-foot orthosis (KAFO), be worn 24 hours a day, seven days a week (23 hours a day). This relieves compression in the knee area, allowing your child’s legs to grow normally. If the brace alone corrects the problem in young children with Blount’s disease, surgery is not necessary. Doctors prescribe Vitamin D and calcium supplements to treat rickets in children. Children with rickets are typically referred to an endocrinologist for assistance with their medical management.

Do Bow Legs Correct Naturally?

As previously stated, yes.  However, the reason for bow legs affects how the problem is treated. Doctors sometimes consider braces as early treatment options.

How Much Time Does It Take for Baby’s Legs to Straighten?

As your baby begins to walk, their legs should begin to straighten. This is most common between the ages of 11 and 18 months. In most cases, the condition is not serious, and there are no long-term consequences. When your child is two years old, if their legs haven’t already straightened, please call and make an appointment with us

How Can I Prevent My Baby from Developing Bow Legs?

There is no remedy to avoid your baby from developing bowed legs. However, parents can avoid certain conditions that cause bowed legs. Make sure your child gets enough vitamin D and calcium in their diet to avoid rickets.

What is the Future of a Baby with Bow Legs?

Bow legs are typically outgrown by the age of two in babies and toddlers. Therefore, they should have no difficulty walking, running, or participating in any activity they desire. Furthermore, after treatment, children with bow legs can lead normal, active lives. Most children with bowlegs grow out of the condition and can walk, run, and play normally. Also, treatment is frequently required for severe bowlegs or bowlegs caused by an underlying condition. Severe bowlegs, on the other hand, can result in leg deformity, difficulty walking or running, and an increased risk of arthritis later in life.

Conclusion – Important Facts for Parents

When is surgery considered necessary for children with bowlegs?

• Surgery may be necessary for children over age 3 who have Blount disease or other significant conditions, especially if non-surgical treatments do not correct the issue.

What treatment options are available for young children with serious conditions like Blount disease?

• For children under age 3 with Blount disease or other serious conditions, the use of braces or other orthopedic devices is recommended to help correct the leg alignment.

What is the purpose of vitamin D and calcium supplements in treatment?

• Vitamin D and calcium supplements are used to address and potentially cure rickets, which can be an underlying cause of bowlegs.

How often should children with bowlegs be monitored?

• Children with bowlegs should have checkups at least every six months to allow the pediatrician to monitor their leg growth and development effectively.

Observation of Bowed Legs

Finally, it’s usually not a cause for concern if your baby has bow legs. Furthermore, most babies and toddlers grow out of the condition without needing treatment. As your kid grows, our doctors will continue to keep an eye on his or her condition. If your child does not outgrow the condition by the age of two, your child’s doctor will discuss treatment options with you. In conclusion, call us and make an appointment to ensure that your child outgrows the condition and goes on to live a normal and healthy life.

Bowed Legs in children are a significant concern that requires early recognition and appropriate management. Understanding the causes, symptoms, diagnosis, and treatment options is crucial for healthcare professionals, parents, and caregivers. By promoting early intervention, following effective treatment strategies, and providing comprehensive rehabilitation, the long-term outcomes for children with this condition allow tends to be fantastic.

It is important to note that this document serves as an informational guide and should not replace professional medical advice. If you suspect that a child may Bowed Legs or any other medical condition, it is recommended that you give us a call and schedule an appointment at one of our three offices –  Arlington, Dallas, Flower Mound, Frisco, and McKinney, Texas.  At the Medical City Children’s and Spine Specialists Medical Practice, our doctors specialize in kids and treat those with Bow Legs.

____________________

Footnote:

MedlinePlus: Bow Legs