Bow Legged

Overview

What are bow legs?

Bow legs (genu varum) is a condition where one or both of your child’s legs curve outward at the knees. This creates a wider space than normal between the knees and lower legs. When your child stands with his or her feet and ankles together, the knees stay wide apart. Your child’s legs may look like a bow, especially when they walk.

Who gets bow legs?

Bow legs are common in infants and toddlers. The condition is rarely serious. Babies born bow legged usually grow out of the condition by the time they turn 18 months old. Bow legs also can occur in older children. You’ll want to have these cases evaluated by a healthcare provider.

Symptoms and Causes

What causes bowed legs in babies?

Bow legs develop for a number of different reasons. The most common cause of bow legs is a condition called physiologic genu varum. When your baby was developing in the uterus (womb), they were in a cramped position. Some of your baby’s bones had to rotate while they were was in your uterus so they could fit in the small space.

Physiologic genu varum is just your child going through the normal developmental process. If your child’s legs haven’t straightened by 2 years old, there may be another reason. These include:

  • Blount’s disease. Blount’s disease (tibia vara) is a growth disorder caused by an issue in the growth plate of your child’s shin bone. Blount’s disease is more common in African American children, children who are overweight and children who walked early.
  • Rickets. Rickets is caused by a calcium or vitamin D deficiency. Deficiencies in these important nutrients make your child’s bones softer and weaker, causing his or her legs to bow. Rickets is very rare in the United States but still occurs often in developing countries.
  • Dwarfism. The most common type of dwarfism is caused by a bone growth disorder called achondroplasia. This disorder can cause bow legs.
  • Other bone issues. Fractures that haven’t healed correctly and abnormally developed bones (bone dysplasia) can cause bow legs.
  • Fluoride or lead poisoning.

What are the symptoms of bow legs?

The main sign of bowed legs is the appearance of your child’s legs. Their knees won’t touch when they stand with their feet and ankles together. The bowing is most obvious when they’re walking. Sometimes children may walk with their toes pointed inward (pigeon toes or intoeing).

However, bow legs usually don’t cause any pain. Bow legs don’t affect your child’s ability to crawl, walk or run. If your child’s bow legs don’t start to improve by age 2, contact your child’s healthcare provider.

Diagnosis and Tests

How are bow legs diagnosed?

Your child’s healthcare provider will do a physical exam and ask about your child’s medical history. But if your child is under 2 years old, your child’s healthcare provider probably won’t do any further tests. Rather, they’ll want to watch the bowing and make sure it resolves on its own as your child grows.

If your child is older than 2, your child’s healthcare provider may measure your child’s legs and watch him or her walk. They may order imaging tests such as X-rays to view the bones in your child’s legs and knees. They may order blood tests to determine whether the bow legs are being caused by a condition such rickets.

Your child’s healthcare provider may refer your child to a doctor who specializes in bones (orthopaedic specialist).

Management and Treatment

Can bow legs be corrected?

Bow legs in babies and toddlers under the age of 2 typically resolve on their own. Your child’s healthcare provider will continue to track your child’s condition. Older children can be treated for bow legs depending on the cause of the condition.

How are bow legs corrected in babies?

No treatment is necessary in babies and toddlers unless the condition is severe. If bow legs continue after age 2, treatment depends on the cause of the condition. Treatment may include special shoes, splints, braces, casts, surgery or treatment of the condition causing the bow legs.

  • Blount’s disease. Early treatment with a splint or leg brace may be all that’s needed.
  • Rickets. Your child’s healthcare provider may treat your child’s condition by adding vitamin D and calcium to their diet. Your child’s healthcare provider may refer you to a specialist for treatment if the rickets is due to a genetic condition.

If bowing continues despite other treatments, surgery may be needed to prevent further damage and correct the issue. Surgery options include:

  • Guided growth. With this procedure, your child’s surgeon will place a small metal plate or staple in your child’s leg. This will temporarily stop growth on the healthy side of the shin bone so the unhealthy side can catch up. Your child’s leg will straighten with their natural growth, and your child’s surgeon will remove the plate or staple once alignment has improved.
  • Tibial osteotomy. With this procedure, your child’s surgeon cuts the shin bone below the knee and reshapes it to fix the alignment. While the bone heals, it’s held in place with a plate and screws inside the leg or a frame that’s positioned outside the leg.

Can bow legs be corrected naturally?

Treatment of bow legs depends on the cause of the condition. Early treatment options may include special shoes, splints, braces or casts.

Prevention

How do I stop my baby from getting bow legs?

There’s no way to prevent your baby from getting bowed legs. But you may be able to prevent certain conditions that are known to cause bowed legs. To prevent rickets, make sure your child is getting enough vitamin D and calcium in their diet.

Outlook / Prognosis

How long does it take for a baby’s legs to straighten out?

As your baby starts walking, their legs should start to straighten out. This typically occurs between the ages of 11 and 18 months. In most cases, the condition isn't serious and there aren’t any lasting side effects. If your child’s legs haven’t straightened by age 2, call their healthcare provider.

When should I worry about my baby being bow legged?

If your bow-legged baby still hasn’t grown out of the condition by the age of 2, call your child’s healthcare provider. They can do a physical exam, check for underlying conditions and determine the correct treatment.

What is the outlook for bow legs?

Babies and toddlers typically outgrow bow legs by the time they turn 2. They shouldn’t have any trouble walking, running or participating in any activity they want. In addition, children with bow legs can go on to lead normal, active lives after treatment.

A note from Cleveland Clinic

If your baby is bow legged, it’s usually not something to be overly concerned about. Most babies and toddlers grow out of the condition without the need for any type of treatment. Your child’s healthcare provider will monitor your child’s condition as they continue to grow. If your child doesn’t outgrow the condition by the time they turn 2, your child’s healthcare provider will discuss treatment options with you. Most often, children go on to lead normal, healthy lives.

Last reviewed by a Cleveland Clinic medical professional on 11/02/2021.

References

  • U.S. National Library of Medicine. Bowlegs. (https://medlineplus.gov/ency/article/001585.htm) Accessed 11/2/2021.
  • American Academy of Orthopaedic Surgeons. Bowed Legs (Blount's Disease). (https://orthoinfo.aaos.org/en/diseases--conditions/bowed-legs-blounts-disease/) Accessed 11/2/2021.
  • Merck Manual. Bowlegs and Knock-Knees. (https://www.merckmanuals.com/home/children-s-health-issues/birth-defects-of-the-face,-bones,-joints,-and-muscles/bowlegs-and-knock-knees) Accessed 11/2/2021.
  • National Institutes of Health. Infantile Blount Disease: A Case Report. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170376/) Accessed 11/2/2021.

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