Bowlegs and Knock-Knees

Bowlegs and knock-knees are common conditions that develop during a child's normal growth and development. In most cases, children will outgrow either condition. However, bracing or surgery may be necessary for patients suffering from Rickets or Blount's disease.

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Understanding Bowlegs and Knock-Knees

Normal vs. Bowlegs vs. Knock-Knees

When a child with bowlegs stands with his or her feet together, if the toes pointed straight ahead, but the knees do not touch, he or she has bow-legs. The medical term for bowlegs is "genu varum", most likely coming from the words thighbone (femur), shinbone (tibia) or both.

When a child with knock-knees stands with his or her legs together, feet pointed straight ahead, and the knees touch but their ankles do not, he or she has knock-knees. The medical term is "genu valgum", which may also come from the words thighbone, shinbone or both.

Growth and Development in Children

A common concern for parents, bowlegs and knock-knees are primarily due to the child’s normal growth and development. However, only a very small number of children need treatment. Understanding how a child’s legs change as they grow is important in understanding these conditions.

During growth, the majority of children normally go through a period of being relatively bowlegged or knock-kneed. Physiologic bowlegs and knock-knees will not affect a child’s ability to crawl, walk, run or play. Some children may walk with their toes pointed in, trip more or appear clumsier than other children their age, and, children at the extremes of the normal growth curve may have bowlegs or knock-knees that often look severe. However, these are symptoms of bowlegs and knock-knees seen in most children, which the child will typically outgrow.

Child Growth and Development

The following is the normal growth and development for children, from infancy to the age of 10:

  • From infancy to 18 months, a child’s legs are initially bowlegged (varus), causing toddlers to often walk with their feet wide apart.
  • When the child is between 1 1/2 and 2 1/2 years, the legs have usually straightened.
  • By 3 to 4 years, the child’s legs typically grow into a knock-knee (valgus) position.
  • Finally, by age 8 to 10 years, the child’s legs have settled in to what will likely be their adult alignment.

Treatment Options for Bowlegs and Knock-Knees

Leg Alignment Graph

For the vast majority of children, treatment only involves observation (allowing growth and time to correct the legs) and parental reassurance. Physical therapy, chiropractic, special shoes, vitamins, and bracing have no effect on the normal development of normal legs.

If the pediatrician does have concerns about the severity of either condition, a referral to a pediatric orthopaedic surgeon for evaluation is often recommended. A referral is typically given if one side is affected more than the other, the deformity is severe, or if there is a significant family history. X-rays may be ordered to confirm the diagnosis or to exclude other problems. Two conditions that may require treatment include Rickets and Blount’s disease.

Rickets Disease

Rickets disease is a disorder caused by a lack of vitamin D, calcium, or phosphate. It leads to softening and weakening of the bones, and may cause bowlegs or knock-knees. Rickets disease is usually diagnosed by the patient’s pediatrician through lab tests or x-rays. While conservative treatments are most often recommended, bracing or surgery may be required, based on disorder severity.

Blount's Disease

Blount's Disease is a disorder caused by an abnormal growth plate in the upper tibia. While the cause of Blount's disease is unknown, it can affect both toddlers and teenagers. Treatment of Blount's disease depends on the severity of the deformity and the age of the child, and may involve observation, bracing or surgery.

Bowlegs and Knock-Knees in Tampa-St. Petersburg, Florida

With 7 fellowship trained pediatric surgeons, the Children's Orthopaedic and Scoliosis Surgery Associates team provides the highest level of comprehensive care to patients in the Tampa area, including St. Petersburg, Sarasota, and Brandon, Florida. The Children's Orthopaedic and Scoliosis Surgery Associates specialize in providing state-of-the-art comprehensive care, both surgical and non-surgical, to patients suffering from congenital orthopaedic anomalies, such as bowlegs and knock knees.

To learn more about bowlegs and knock-knees, please schedule an appointment at one of our Tampa-St.Petersburg locations.