Bowlegs vs. Knock Knees: When Should Parents Be Concerned?

Children undergo rapid changes as they grow. However, knowing which changes are normal and when to worry is crucial for their healthy growth and development. 

Two common conditions that are frequently observed in growing children are bowlegs (genu varum) and knock knees (genu valgum). These conditions are typically seen in toddlers and young children, and while they are often part of normal growth and development, there are certain instances when they may raise concerns. Knowing the differences between bowlegs and knock knees, their natural progression, and when to seek advice is important for every parent to know.

What are Bowlegs and Knock Knees?

Bowlegs (Genu Varum)

In bowlegs, the child’s knees are wide apart, and the lower legs curve outward, creating a bow-like appearance.

This condition is often seen in infants and toddlers as they start walking. The legs usually straighten out naturally as the child grows and begins to walk more steadily.

Knock Knees (Genu Valgum)

In knock knees, the knees touch or nearly touch while the ankles remain apart. This gives the appearance of the legs bowing inward.

This condition is common in children aged 4 to 5 years. Like bowlegs, it is often part of the normal development process and generally resolves by the time the child reaches 7 or 8 years of age.

Are Bowlegs and Knock Knees Normal?

Both bowlegs and knock knees are often a part of the normal developmental stages, however, the persistence of these conditions requires medical attention. 

Bowlegs: It’s completely normal for children under the age of 2 to have bowlegs as they begin to stand and walk. The legs will generally begin to straighten as the child grows, and by the time they are 7 or 8, most children will have straight legs.

Knock Knees: This condition typically appears around age 2 and peaks between ages 3 and 4. As the child grows, the legs naturally straighten out. Most children outgrow knock knees by the age of 7 or 8, and it rarely causes long-term problems.

When Should Parents Be Concerned about these conditions?

While most cases of bowlegs and knock knees resolve naturally, there are some situations where parents should seek medical advice. Below are some symptoms that should alert the parents. 

Severe or Persistent Deformities

If the child’s legs appear significantly bowed or the knees remain widely apart beyond the age of 3 or 4, or if knock knees persist past the age of 8, it could indicate an underlying issue.

Uneven Leg Growth

Normally, both legs in a child should develop symmetrically. If one leg appears to be growing differently than the other, it could be a sign of an underlying problem that needs medical attention.

Pain or Discomfort

Most cases of bowlegs and knock knees do not cause pain. However, if discomfort, limping, or difficulty in walking accompany these conditions then it is important to consult a healthcare professional.

Associated Symptoms

Symptoms like swelling, redness, or bruising around the knees or joints, may indicate an injury or a condition such as rickets (a vitamin D deficiency), or a metabolic disorder. Early consultation in such cases can lead to effective treatment. 

Rapid Worsening

If the condition seems to worsen rapidly rather than improve over time, a visit to a doctor is advisable. This could indicate a more serious issue such as developmental dysplasia of the hip or a bone disorder.

Why can a child have persistent Bowlegs or Knock Knees? 

When bowlegs or knock knees don’t resolve naturally, they may be caused by underlying several factors. Some of them include: 

Rickets: This is a condition caused by the deficiency of vitamin D, calcium, or phosphate, leading to weakened bones and leg deformities.

Blount’s Disease: A growth disorder of the tibia bone that causes the legs to bow outwards. This condition is more common in overweight children and those who start walking early.

Genetic Conditions: In some cases, inherited disorders such as osteogenesis imperfecta or skeletal dysplasias can cause abnormal leg alignment.

Injury or Infection: Previous fractures, infections, or abnormalities in bone growth can result in misalignment of the legs and the persistence of this condition.

How are abnormal bowleg and knock knees detected? 

A pediatric orthopedician is an expert who treats the diseases and conditions of the bones and joints in children. In case of suspicion of abnormal bowlegs and knock knees, the following can be expected:

Physical Examination: The alignment of the legs, signs of pain or discomfort, and the child’s gait will be observed by the specialist thoroughly.

X-rays: An X-ray is usually necessary to evaluate the bones and joints more closely and rule out other conditions.

Blood Tests: In some cases, blood tests may be recommended to check for conditions like rickets or other metabolic disorders.

What are the Treatment Options? 

Treatment options depend on the severity and underlying cause of the condition. Most children with mild bowlegs or knock knees may not need treatment, and the condition resolves on its own as the child grows. For children needing treatment, braces or orthotics to correct alignment, or surgery in severe cases may be required to realign the bones. 

Bowlegs and knock knees are common conditions in young children, and in most cases, they are a natural part of growth and development. However, parents should be aware of the signs that might indicate the need for medical evaluation. If you notice any abnormal leg alignment, pain, or other concerning symptoms, it’s always best to consult with a pediatric orthopedician. Early intervention can help ensure the best outcomes for your child’s long-term health and mobility.