"My Baby Has Bow Legs. Should I Be Worried?"

My daughter is five-and-a-half months old. Ever since her birth, she was an eager beaver. She always kicked much more vigorously than I had ever seen in any baby. She could turn over quite early, and at the age of five months, she wanted to stand all the time. This was of course with support.

And this being our first baby, we were quite amused by her efforts, and let her do what she wanted. But, we noticed that her legs started bowing. I had seen bow legs in children before, and we were quite worried.

During the next visit to the paediatrician, we brought it up. The doctor was quite understanding and reassured us that this condition is quite common in babies. In fact, the most common cause of bow legs in children is the tight, limited space in the uterus where they develop. 

Does this mum’s story seem familiar to you? Perhaps you too are worried about bow legs in children. That’s why we want to help ease your worries and tell you exactly what causes it, and what can be done about it. 

Bow Leg: What Is It?

Bow legs, also known as genu varum, are when the feet and ankles are in contact and the legs curve outward at the knees.

Bow legs are common in babies and young children. Sometimes older children do this as well, which results in a wider gap between the knees and lower legs than usual. The knees stay wide apart while your youngster stands with his or her feet and ankles together. When your toddler walks, their legs may resemble a bow.

It normally disappears without therapy by the time a child is 3 to 4 years old and is almost never serious.

Baby Bow Legs

Due to their folded positioning while in the mother’s womb, babies frequently arrive bowlegged. As the youngster learns to stand and walk, they will outgrow this according to normal growth trends.

For this reason, leg bending is common in children up to the age of two. In actuality, there is a wide range of what is seen as normal. When a youngster starts to stand or walk while bearing weight on them, their legs typically start to straighten (usually between 12 to 18 months old).

By the time a child is two to three years old, the leg angle usually changes and starts to resemble a knock knee, when the knees bend inward and toward one another. Most children’s knees develop a straighter alignment that is considered typical after they become six years old.

In addition to the above-discussed normal patterns, a parent should seek medical advice to assess whether their kid is at risk of developing a bowleg or knock knee deformity if:

• the child’s thighbone to shinbone angle is out of the ordinary range.
• outside of the usual pattern, the knees point in one way while the foot falls in another.
• compared to the opposite leg, one is noticeably more (or less) inclined.

Signs & Symptoms of Bow Legs

The most typical sign of a bowleg ailment is when a person stands with their feet and ankles together but their knees do not contact. This results in the legs bowing, and if it persists after the age of three, it may indicate a bowleg deformity.

Additional signs and symptoms of bowlegs include:

• hip or knee pain
• hips’ decreased range of motion
• running or walking with difficulty
• unstable knees
• negative thoughts about appearance

Adults with bow legs who were not identified or treated as children frequently develop knee arthritis. Adult patients with bowleg who have had it for a long time overload the inside (medial compartment) and strain the exterior (lateral collateral ligament), resulting in discomfort, instability, and arthritis.

An osteotomy should be done to realign the knee in order to avoid or postpone the necessity for a knee replacement.

How Do Babies’ Legs Develop

As babies develop in the womb, their legs are folded – or bowed – in the foetal position. When they are born, they still prefer to stay in the foetal position. And that is why they love swaddling (well, at least most of them do!).

In the initial few months of development, the bowing is not that noticeable as there is no weight bearing. The bones are developing, but they are quite different from the adult bones.

The adult bones get deposited with calcium – doctors call this process “ossification.” The bones of a growing child are not completely ossified. As a result, they are not as rigid as adult bones.

Consequently, they can bend due to constant pressure. The good news is, they can bend right back into shape!

So, as the baby starts standing, walking, and consequently running, they get bow legs. This is a physiological (read normal) phenomenon called genu varum. 

For the normal variant:

• The bend is bilateral – equal in both knees.
• One limb does not appear shorter than other.
• It disappears after the age of three.

What Might Follow…

After the age of three, the bones of the legs start correcting, and the bowing, if any, disappears. However, it is often followed by knocking of the knees, where the legs bend the other way around at the knees. 

It is commonly seen between the ages of three and five years. This is, again, physiological (read normal) and is attributed to growing up. Knock knees are called genu valgum in medical talk. This condition disappears by the age of eight. 

What Causes Bow Legs in Children?

Bowleg syndrome can be brought on by a variety of conditions, including diseases like Blount’s disease, incorrect fracture healing, vitamin deficiency, and lead poisoning.

Bowleggedness is a symptom of the following diseases and conditions:

• unnatural bone growth (bone dysplasia)
• Blount’s illness (more information below)
• Paget’s illness (a metabolic disease impacting the way bones break down and rebuild)
• incorrectly repaired fractures
• Lead poisoning
• Fluoride toxicity
• Achondroplasia (the most frequent kind of dwarfism) (the most common form of dwarfism)
• Rickets (a bone-weakening condition induced by a vitamin D deficiency)
• injury to the growth plate

Who Gets Bow Legs?

Babies and young children frequently have bow legs. Rarely is the condition serious. Bow-legged newborns typically outgrow the deformity by the time they are 18 months old. In older kids, bow legs can also happen. You should have a medical professional analyse these cases.

Blount disease or another medical problem is typically the cause of bow legs in older children. Blount disease affects children more frequently who:

• are overweight
• started walking at an early age
• have a family member who had the condition

How to Diagnose Bow Legs

Medical professionals examine the youngster and inquire about their medical background. If the child is under 2 years old, is in good health, and has equally bowed legs, they most likely won’t perform any testing. Instead, they’ll keep an eye on the child to ensure that the bow legs get better as they age.

Some kids might need to see an orthopaedic doctor (bone specialist) if:

• The legs are not straightening on their own.
• The bowing is asymmetric (the legs are bowed to different degrees).
• The child has symptoms such as pain, limping, weakness, or trouble running.

An X-ray might be needed to look for Blount disease or rickets. If rickets is suspected, blood tests can help make that diagnosis.

When Is Bowing of Legs Not Normal?

While in most cases, bowing of knees in children is physiological, there are instances where it is due to some underlying condition. The most common pathological conditions causing bow legs in children are Rickets and Blount’s disease. 

Blount’s Disease

This is caused due to an abnormality in the growth plate in the bone of the shin (tibia). The cause is not known, but there might be some genetic causes to it. It is linked to childhood obesity and early walking. It can occur in one or both legs, and it might even be hereditary. 

Before the age of three, it is not possible to distinguish between the normal genu varum (bow legs in children) and Blount’s disease. So if the bowing is persistent after the age of three or four years, you should definitely be concerned. 

Rickets

Rickets is caused due to a deficiency of Vitamin D. We get our daily dose of vitamin D through sufficient exposure to sunlight. Vitamin D is essential in calcium metabolism, and it helps the deposition of calcium in the bones and teeth. So you can imagine that the bones would bend under pressure if the calcium deposition is not optimal. 

There are various causes of rickets, and it is more common in exclusively breastfed babies. It is seen more commonly in children who are:

• dark-skinned
• have significantly less exposure to sunlight
• may have a genetic condition affecting Vitamin D production
• have coeliac disease that interferes with the vitamin D metabolism

There are other symptoms associated with Rickets as well, so if the bowing is due to it, it is most likely diagnosed well in time. 

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

Bow Leg Correction

In infants and young children, no therapy is required unless the condition is severe. The type of treatment depends on the source of the problem if bow legs persist after age 2. Special shoes, splints, braces, casts, surgery, or treatment of the ailment causing the bow legs are all possible forms of treatment.

• Blount’s disease. Perhaps only early intervention with a leg brace or splint is required.
• Rickets. Adding vitamin D and calcium to your child’s diet may help your child’s condition, according to their healthcare practitioner. If your kid has rickets because of a hereditary disorder, your child’s doctor could recommend that you seek therapy from a specialist.

Surgery can be required to stop more damage and fix the problem if bowing persists in spite of prior treatments. Options for surgery include:

• Guided growth. The surgeon doing this treatment will insert a tiny metal plate or staple into the leg of your child. In order for the diseased side of the shin bone to catch up, this will momentarily halt growth on the healthy side. Your child’s surgeon will take out the plate or staple once alignment has improved because their normal growth will cause their leg to straighten.
• Tibial osteotomy. The shin bone below the knee is sliced and reshaped by your child’s surgeon to correct the alignment during this treatment. A plate and screws inside the leg or a frame outside the leg are used to hold the bone in place while it heals.

How Much Does Bow Leg Surgery Cost

If you’re thinking about having surgery for bow legs, you might be curious about the price. Bow legs surgery expenses might vary based on the institution and the physician, but they normally range from $2,000 to $10,000. The kind of operation done and if you have insurance are two factors that may have an impact on the overall cost of bow legs surgery.

When to Be Concerned

It is quite scary as a new parent to notice anything irregular with your baby. And bowing of legs can be quite alarming. To make sure that your baby does not have bow legs when he grows up, you should ensure that you don’t rush your child into early walking! In addition, ensure that:

• He has an adequate intake of Vitamin D. So ensure outdoor time and a good diet.
• Introduce nutritional supplements especially if you have an urban lifestyle.
• Overweight children may continue to have problems with their knees, so ensure he gets plenty of exercise.
• Look out for the red flags (see below).

Your child does not need special footwear, braces, or correction if it is physiological bowing. 

The Red Flags

• The bowing is quite severe and interferes with walking.
• It persists after the age of three.
• The child is limping or in pain.
• Only one leg is affected.
• The child appears very small for his age.

If you do not observe these red flags, your child is just growing up and the bowing is something he might just go through. If you are concerned though, don’t hesitate to visit your doctor. 

The majority of bowlegged kids recover from their condition and can walk, run, and play without any difficulty.

Treatment is frequently necessary for severe bowlegs or bowlegs brought on by an underlying disease. Otherwise, severe bowlegs can result in limb deformity, difficulty running or walking, and an increased chance of developing arthritis as an adult.

Updates by Matt Doctor