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300 Longwood Avenue
Boston, MA 02115
(617) 355-6000
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My Child Has:
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Bowlegs
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Children with bowlegs, when standing straight with toes pointed forward, have ankles that touch but knees that do not. Bowlegs is a condition involving the shin and thigh (tibia and femur) bones. During the first years of life, bowlegs are part of normal growth and development and are obvious by two months of age. Most infants' legs exhibit some degree of bowing until they have been walking for a few years. During this time, the legs may also appear "knock-kneed," with both knees pointing inward. This type of angular deformity is considered "physiologic" and usually resolves on its own by the time a child is four or five years old, although it may persist until age eight.
If a child remains bowlegged, however, bone malformation or an underlying bone disease may be present. The most commom of these is Blount's disease (tibia vara), an abnormal growth in the upper part of the shinbone (tibia) where bone growth occurs. As a result, the shinbone sharply curves out or bows, just below the knee. A child with Blount's disease is forced to walk with the affected knee flexed, which increases bowing of the leg. This can lead to severe knee joint problems.
Blount's disease occurs more frequently between the ages of 1 to 3, but also may appear during late childhood and adolescence (9 years or older). It is classified as infantile (1-3 years), juvenile (4-10 years) and adolescent (11 years of age or older) Female children, obese or short children, or children who walk at an early age are most often affected by this disorder.
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Most often, bowlegs develop as part of natural growth, although certain conditions, such as Blount's disease and bone malformations present at birth, may cause a child's legs to bow. Some metabolic disorders, such as rickets, a disease caused by Vitamin D deficiency, can also cause bowlegs. This occurs when Vitamin D deficiency affects and weakens a child's bones, causing the legs to bow.
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The following are some common symptoms associated with bowlegs:
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- Excessive tripping
- In-toeing (walking with toes turned in)
- Knock-knees
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Bowlegs are obvious when a child stands with legs straight and toes pointed forward. Your child's physician can determine the severity of bowlegs by observing the position of a child's legs, knees, and ankles and by measuring the distance between the knees. The doctor will also want to observe your child while walking, both coming and going, to assess the degree of internal rotation.
To document the positioning of the bowlegs and to look for any underlying bone deformities, your child's doctor may recommend X-ray films of the knees. During infancy, however, there is no clear distinction between Blount's disease and physiologic bowing. If your child is under 15 months of age, the X-ray can document the degree and location of bowing, but cannot be used to distinguish physiologic bowing from Blount's disease until the baby is older.
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Specific treatment for bowlegs will be determined by your child's physician based on:
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- your child's age, overall health, and medical history
- the extent of the condition
- the cause of the condition
- your baby's tolerance for specific medications, procedures, or therapies
- expectations for the course of the condition
- your opinion or preference
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Depending on your child's age, the doctor will probably advise delaying treatment of bowlegs to give leg bones a chance to straighten naturally.
If bowing of the legs does not correct itself, or increases after a child has been walking for some time, a physician may recommend corrective appliances. Night braces help to pull the legs slowly into a straighter position.
Bowlegs caused by an underlying disease cannot be corrected completely until the disease itself is treated. A child usually wears a corrective brace during part of the treatment of the disease. If leg bowing is severe, and cannot be corrected through the use of appliances, a physician may recommend a surgical procedure called an osteotomy. An osteotomy is an operation on the upper part of the shinbone that would correct the lower limb alignment.
Treatment of Blount's disease usually involves a combination of non-operative measures that include wearing a special brace and osteotomy. This brace, known as a modified knee-ankle-foot orthosis (KAFO) is designed to prevent knee flexion and must be worn day and night (23 hours a day). This brace works by releasing the compression forces in the area of the knee to allow the resumption of normal growth. Young children with the disease may not need surgery if the brace alone corrects the problem.
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The information on this website should not be taken as medical advice,
which can only be given to you by your personal health care professional. |
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Copyright © Children's Hospital Boston. All rights reserved. |
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