Bowed legs, also known as Blount’s disease, is a condition where one or both legs of a child arch outward, creating a noticeable gap between their lower legs and knees when they stand with their feet together. While bowed legs are common in toddlers, they should naturally improve as a child grows. However, if the condition persists past the age of three, it may be due to underlying causes such as Blount’s disease, rickets, or other less common genetic conditions.
In most cases, bowed legs in children do not cause pain. Toddlers may also turn their feet inward, a condition known as Intoeing, which sometimes accompanies bowed legs.
One of the primary signs that something might not be right is an awkwardness when moving around. While some children may walk with an exaggerated bow in their legs, it typically doesn’t affect their motor development or coordination.
However, if this condition persists into adolescence, it can lead to soreness and discomfort around the hips, knees, and ankles due to the extra strain placed on these joints. Parents may also become concerned if their child frequently stumbles over their feet, especially when there is additional inward rotation.
Left untreated, Blount’s disease, or rickets in infancy, can result in progressive leg deformities during childhood and adolescence, leading to chronic pain around the knees due to excessive strain on the joints.
Several factors can cause bowed legs, including:
Physiologic genu varum
In children aged two or younger, the bending of the legs is typically viewed as an expected variation, known as physiologic genu varum. It can take up to 18 months before signs of improvement are seen. By ages three to four, this natural curving should have completely resolved, and the child’s legs will return to their normal state.
Blount’s disease, also known as Blount’s syndrome, is a disorder that commonly affects both young children and adolescents. It arises due to abnormal development of the growth plate, which is located at either end of the long bones, specifically in the upper part of the shinbone (tibia). This condition plays a pivotal role in determining the length and shape of an adult bone.
It can be challenging to distinguish infantile Blount’s disease from the expected bowed legs of early childhood in children aged two years or younger. However, as a child approaches three years of age, this condition becomes more pronounced, and clear evidence of its presence may be revealed through an X-ray.
Rickets is a disease that can lead to skeletal deformities like bowed legs. It results from a deficiency of calcium, phosphorus, or vitamin D, which are crucial for bone development.
Nutritional rickets is rare in developed countries due to the enrichment of foods, especially dairy products, with Vitamin D. However, it can occur in some cases, particularly in exclusively breastfed children or those with genetic disorders affecting vitamin D absorption. This variant of rickets is inherited from parent to child.
Physiologic genu varum
No active treatment is generally required, but regular checkups every six months are recommended to monitor the resolution of bowing.
Diagnosis and treatment of Blount’s disease in young children are essential for correcting bowed legs, with braces often being an effective remedy. However, as adolescents grow, bracing may become less effective, and other treatments may be needed.
If your child has been diagnosed with rickets, your doctor will refer you to a metabolic specialist for further medical management and regular orthopaedic reviews. In most cases, medication can be prescribed to control the effects of this condition.
Physiologic genu varum
In some cases where the condition persists into adolescence and causes cosmetic concerns, corrective surgery using guided growth techniques is a viable option to alleviate this aesthetic issue.
Surgical intervention may be necessary before the age of four if bracing proves ineffective in halting the progression of leg bowing. Corrective surgery is also essential for adolescent patients with Blount’s disease to rectify bowed legs.
Surgical treatment might be recommended if medication fails to improve the condition.
The types of surgeries offered include:
The most common surgical treatment for bowed legs is guided growth, which involves attaching a small metal plate or staple to the healthier side of the upper shinbone to temporarily halt growth in this area. This pause in growth provides the abnormal side with an opportunity to ‘catch up,’ allowing the leg to straighten naturally through expansion. Once the alignment is corrected, the apparatus is removed, allowing growth to resume.
This procedure involves the careful reshaping and repositioning of the shinbone beneath the knee to achieve ideal alignment. The bone is stabilised using internal metal plates and screws or an external frame. After surgery, a cast may be required for protection during the healing process. Physical therapy exercises may also be recommended to regain strength and range of motion.
To learn more about the high tibial osteotomy procedure, as well as what you can expect prior to, during, and after the surgery, please visit our Tibial Osteotomy page.