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Bowed Legs


Bowed legs in a toddler are very common. When a child with bowed legs stands with his or her feet together, there is a distinct space between the lower legs and knees. This may be a result of either one, or both, of the legs curving outward. Walking often exaggerates this bowed appearance. The bowing usually begins to improve slowly from 18 months of age and by 3 or 4 years old the legs have a normal appearance.


Bowed legs are most evident when a child stands and walks. The most common symptom of bowed legs is an awkward walking pattern. Toddlers with bowed legs usually have normal coordination, and are not delayed in learning how to walk. The amount of bowing can be significant, however, and can be quite alarming to parents and family members.
Bowed legs do not typically cause any pain. During adolescence, however, persistent bowing can lead to discomfort in the hips, knees, and/or ankles because of the abnormal stress that the curved legs have on these joints. In addition, parents are often concerned that the child trips too frequently, particularly if intoeing is also present.


If your child is under age 2, in good health, and has symmetrical bowing (the same amount of bowing in both legs), your doctor will most likely tell you that no further tests are needed. However, if your doctor notes that one leg is more severely bowed than the other, or if the child is older than 2 ½, he or she may recommend an x-ray of the lower legs. An x-ray of your child's legs in the standing position can indicate Blount's disease or rickets if they are present.


Bowed legs nearly always spontaneously self-correct as the child grows. This correction usually occurs by the age of 3 to 4 years. Even though no treatment is used at this stage, the doctor would monitor the child’s bowing and request to see him/her every six months. In rare cases when bowing does not completely resolve by early adolescence, it may cause the child and family to have cosmetic concerns. If the deformity is severe enough, then surgery to correct the bowing may be needed.

Untreated infantile Blount's disease or untreated rickets can result in progressive worsening of the bowing in later childhood and adolescence. These children complain of leg discomfort (especially in the knees) due to the abnormal stresses that occur on the joints.

Treatment with a brace is usually used for children in early stages of infantile Blount’s disease but is not as effective in adolescents. The key is to catch the disease early. If bowing continues to progress in a child with infantile Blount's disease despite the use of a brace, surgery will be needed by the age of 4 years. Surgery may stop further worsening and prevent permanent damage to the growth area of the shinbone.

If your child has rickets, your doctor will refer you to a metabolic specialist for medical management, in addition to regular orthopaedic followup. The effects of rickets can often be controlled with medication but when the deformities persist despite the use of medication, surgery may be needed.

After surgery, a cast may be applied to protect the bone while it heals. Crutches may be necessary for a few weeks, and your doctor may recommend physical therapy exercises to restore strength and range of motion.