Some children have curving or bowing of their legs; when sitting, standing or walking, their knees seem far apart. The medical term for this is genu varum. In the first 12 months of life, bowed legs are normal (physiologic). The legs naturally bow outward and begin to straighten as the baby/toddler grows. For most children, the bowing tends to improve by about 18 months, but in many children, it persists a little longer. By age four, it is common to see the child become knock-kneed, and then by ages seven to 10, the legs have usually straightened.
Occasionally, the bowing may be due to an abnormality of the growth plate at the top of the shinbone (tibia) at the knee, infection or a specific condition affecting the bones. Your physician will explain the cause to you.
Your physician will ask you about your child’s health, growth, and development and examine their legs. If the bowing is very severe, is not equal in both legs or if your child is very small for their age, your physician may want to take an X-ray of the legs. Physicians will also consider x-rays for patients who have bowing that is not getting better after ages two or three. The appearance of the x-ray will help determine if treatment is necessary.
For normal (physiologic) bowing, the treatment is generally observation. Special shoes, casting or bracing do not help. If your doctor determines that the bowing is physiologic (normal), the bowing should improve by the time they are about two or three years old. You may want to take a picture of your child standing with the legs uncovered (for example wearing a t-shirt and a diaper) in front of a blank wall. Several months later, you can take another picture to compare with the first to see if your child’s legs are strengthening. Even if your child ends up with a small amount of bowing as an older child or adult, they should still be able to play sports and lead a normal life.
We recommend a return visit to see a pediatric orthopaedist if the bowing has not resolved or significantly improved by age three. For other causes of bowing, your doctor will discuss treatment options with you including bracing and possible surgery.