Children with bowed legs is a fairly common syndrome at birth. However, the legs of most babies straighten out as they grow. Yet, if the condition persists, parents can take active measures to optimize health, wellness and restoration of normal leg anatomy.
The pace of growth and development in growing babies is very fast as every new dawn brings a new surprise for parents. In fact, the most anticipated milestone (that most parents wait) for is when babies begin to walk. Most babies learn to walk with support by 9 to 10th month of age. However, walking may be delayed in certain babies for up to 15th to 16th month. Quite often, parents also notice some physical and developmental issues (such as bowing of legs) when the babies learn to walk.
What is bowing of legs in babies?
Bowing refers to a distinct space or angle between lower legs and knees when baby stand with her feet in one line. Bowing of legs may involve only one leg or in most cases may affect both the legs (at variable angles or extent). In accordance with the research conducted by Heath and Stahili (1), babies under the age of 2 years physiologically develop bowing (that is absolutely normal).
Usually, the bowing reaches maximum angle by the age of 6 months, after which the angle starts to decline and most babies have no angle (neutral direction) of legs with knees by the age of 18 months. However, if the baby continue to manifest the features of bowed legs beyond the age of 2 years, it is recommended to look for pathological causes of bow legs.
What are some of the common causes of bow legs in children?
In certain situations, bowing is often overlooked by the parents at the young age, but may become noticeable at the time of adolescence due to onset of disturbing symptoms.
Here are some of the frequently encountered causes of bow legs in children:
- Physiological genu varum
Vast majority of babies have a genetic condition that is normal and is not associated with any pathology. This is other than the fact that some babies may appear bowed leg during their infancy and early childhood years. According to a study published in Nigerian population (2), investigators identified that the 4.6% of the sample of primary school children had physiological genu varum. Report also concluded that boys are 3 times more likely to have genu varum as compared to females (3.5% in boys vs. 1.1% in girls).
- Vitamin D deficiency
Rickets or chronic deficiency of vitamin D can also lead to bowed legs in young children. The worldwide prevalence of vitamin D deficiency is high in countries where sunlight exposure is low. However, babies who consume high calcium and vitamin D foods are usually at much lower risk of developing rickets. The incidence of vitamin D deficiency rickets is fairly high in developing countries (3).
- Blount’s Disease
Abnormal bone growth in babies at the level of tibia can also lead to bowed legs. In toddlers and during childhood, bracing can often help in correcting the Blount’s disease. In teens or adults, surgery is often needed for optimal restoration of normal architecture. According to data reported in research report by P. Putzeys (4) and associates, the current prevalence of Blount’s disease is less than 1%.
- Other less common causes of bowed legs in children are:
- Osteogenesis Imperfecta
- Tibia Vara
- Bone infections
- Inherited skeletal defects
- An early childhood fracture that healed imperfectly
Parenting Tips For Children With Bowed Legs
It is important to realize that most babies with bowed legs can be managed without surgical intervention. This is provided only if parents take some serious interest and adopt practical strategies to promote health and wellness in their babies at a younger age.
Here is what parents can do:
- Parental education and learning about the condition
Parents should learn and educate themselves about the growth and development patterns in babies. Knowing the primary and secondary milestones along with physiological and pathological variations often help in early identification of disease states in babies and thereby reduce the risk of complications.
Although, bowing of legs may improve with time, parents should know when to consult physician. For example:
- If you child is complaining of moderate to severe pain (bowing itself is usually painless)
- If your child has started limping
- If bowing involves one leg or limb only
- If bowing is worsening at a very rapid pace
- If bowing develops after 5- 7 years of age
- Keeping up with the pediatric appointments
Seeing a pediatrician at intervals is helpful in confirming if the baby is developing normally. In case of Blount’s disease, healthcare providers may advice bracing at an early age, in case of rickets, a much concise metabolic assessment is generally needed followed by repeated medical evaluations. In the case of physiological genu varum, the pediatrician may review the changes or improvement at periodic intervals (once every 6 months).
- Diet and nutrition
Intake of healthy and nutritious diet reduces the risk of developing bone issues, skeletal deformities and recurring episodes of inflammation that further disintegrates the joint cartilage. Calcium, vitamin D supplements, mineral supplements and other proteins and vitamins are essential for normal development of these children. It is often advised to consult a nutritionist to deliver quality nutrients without increasing the risk of weight gain in these children.
- Use of proper shoes
According to a research published in the peer reviewed journal Pediatrics (6), author suggested that certain corrective shoes can be effectively used for early management of foot and leg disorders. For example, if parents employ shoes with certain features like reverse lasts, wedges, torque heels, straight lasts, Thomas heels, scaphoid pads and shoe lifts, the risk of leg and foot deformities and mal-developments can be reduced significantly. However, such interventions should only be taken after a detailed discussion with podiatrist and pediatrician.
- Ask doctor about corrective active or passive exercises
Depending upon the cause and pathogenesis of children with bowed legs, doctors may advise different lifestyle modifications and/ or corrective exercises to manage bowing in children. For example, doctor may advise delaying the walking in children in case of early onset bowing or may advise to limit the walking on both feet.
Leg straightening exercises are also helpful. These exercises decreases the pressure, stress and strain on your muscles and soft tissues around knee and legs. A few examples include:
- Lie flat on your stomach on an exercise bench.
- Bend your knees (in flexion) and slowly touch your buttocks with your heels.
- Repeat the exercise after fully extending your legs.
- Once you get used to tis exercise, you can also use weights on your feet.
- Early treatment
Bracing is mainly used by pediatricians for the early management of Blount’s disease. Most varieties of bowed legs improve as the baby grow, yet healthcare providers may advice multiple treatment and holistic modalities for early restoration.
Professional treatment by physical therapists (such as therapeutic massage) is also helpful. Healthcare providers suggest that massage therapy may take a longer period of time but if initiated at an earlier stage, therapeutic massage can help in reducing the bowing as the child grows.
- Yoga and pilates
Pilates is another holistic method of managing bow legs. It allow muscles and soft connective tissues of the body to realign with the anatomical architecture of the muscles and bones. In addition it indirectly improve core body strength and restore healthy posture (that is often altered in children with bowed legs). Here are some easy tips:
- Lie on your back (ideally on a flat surface such as ground)
- Slowly lift your legs in the air and hold as long as possible
Another exercise that also helps is:
- Lie on yoga mat and align your legs together
- Lift both legs in the air (while legs both aligned)
- Hold your pelvis also while supporting the upper torso with upper limbs
- Reassurance to children
Often times when bowed legs begin to interfere with physical activities or day to day life functions, children develop mood swings, agitation, complex or depression. In all such cases, it is the duty of parents to reassure the children via counseling to prevent mental issues.
Why should you take a serious interest in the management of bow legs?
As a parent, you should take serious interest in the development and growth of your child. Not only because early management can improve the outcome several times, but also limit the incidence and severity of complications.
- Maintenance of normal body weight
Bowed legs (due to any of the reasons listed above) suggests that the bones and associated connective tissue are under more stress and pressure due to poor angulation or unequal distribution and alignment of joints. Therefore parents should prevent weight gain in children by promoting healthy eating habits, limiting junk food intake and promoting normal physical activities.
It is also observed that obese babies are at much higher risk of developing aggressive joint damage in the setting of bow legs. The risk is even higher if bone or skeletal disorders run in families and in situations when the child is short-statured.
- Know the outcome or long term complication to manage the issues
Most importantly, knowing long term complications or outcome of untreated bow legs in children is also very useful. Often times, despite treatment and strategic interventions, bowing in legs does not resolve completely. In such cases, child may develop arthritis, discomfort while walking, increasing curvature of knee and leg (more prominent bowing) and other similar issues. Other common issues are:
- Psychological issues as a result of disability, bullying by peers.
- Chronic pain and recurring episodes of inflammation involving other joints of lower limb and pelvis.
Treatment Of Bowed Legs
Surgical intervention is needed in babies who develop bowed leg as a result of rickets, Blount’s disease or physiological congenital genu varum (that does not respond to lifestyle modifications). You should speak to the pediatrician in case the bowed legs are interfering with the quality of life of your child. Here are some common surgical interventions that are safe, effective and associated with excellent results (especially if the cause of leg bowing is due to Blount’s disease).
- Taylor Spatial Frame: (it is a special device that correct bowing by acting as an external fixation source to hold and support the bones together).
- Hemi-epiphysiodesis: A procedure that restricts the growth of normal bone so that the diseased bone catches up in growth and realign with the normal bone to allow optimal leg straightening.
- Osteotomy: The cutting, realigning and internal fixation of bone via screws and plates is referred to as osteotomy.
Once you start researching, you will come with many different strategies that may be used to promote leg straightening in your children with bowed legs.
1. Heath and Stahili, L.T. (1993): Normal limits of knee angle in white children genu vary and genu valgum . J. Pediatr. Orthop, 13: 159 -63
2. Udoaka, A. I., Olotu, J., & Oladipo, G. S. (2012). THE PREVALENCE OF GENU VARUM IN PRIMARY SCHOOL CHILDREN IN PORT HARCOURT, NIGERIA. Scientia Africana, 11(2), 115-117.
3. Aggarwal, V., Seth, A., Aneja, S., Sharma, B., Sonkar, P., Singh, S., & Marwaha, R. K. (2012). Role of calcium deficiency in development of nutritional rickets in Indian children: A case control study. The Journal of Clinical Endocrinology & Metabolism, 97(10), 3461-3466.
4. Putzeys, P., Wilmes, P., & Merle, M. (2013). Triple tibial osteotomy for the correction of severe bilateral varus deformity in a patient with late-onset Blount’s disease. Knee Surgery, Sports Traumatology, Arthroscopy, 21(3), 731-735.
5. Goldman, V., & Green, D. W. (2010). Advances in growth plate modulation for lower extremity malalignment (knock knees and bow legs). Current opinion in pediatrics, 22(1), 47-53.
6. Staheli, L. T., & Giffin, L. (1980). Corrective shoes for children: a survey of current practice. Pediatrics, 65(1), 13-17.
7. Riegger-Krugh, C., & Keysor, J. J. (1996). Skeletal malalignments of the lower quarter: correlated and compensatory motions and postures. Journal of Orthopaedic & Sports Physical Therapy, 23(2), 164-170.
8. Jain, N., Narain, S., Gupta, A. K., Nag, H. L., & Kabra, S. K. (2002). Blount’s disease: A lesser known cause of Bowlegs mandating early differentiation from physiological bowing. The Indian Journal of Pediatrics, 69(2), 189-191.