Children's Hospital Colorado

Bowed Legs (Genu Varum)

What is bowed legs?

Bowed legs (also known as genu varum or bowlegs) is a common condition occurring in infants and toddlers. In many cases, this condition corrects itself as a child grows.

A child with bowed legs has a distinct space between his or her 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.

What causes bowed legs?

In most cases bowed legs are due to a fetus' loose muscle (laxity) and position in the uterus, which they eventually outgrow.

Who gets bowed legs?

Many babies are born bowlegged because their legs were folded tightly across their bellies in-utero (during pregnancy inside the mother). Bowed legs usually straighten once babies with this condition start to walk and their legs bear weight. By age 3, most kids grow out of the condition.

Bowleggedness is a condition very common in toddlers. Adolescents occasionally have bowed legs and should be evaluated for other causes such as limb length discrepancy (a difference in length between the legs), Blount's disease, in which the abnormal growth in the upper part of the shin bone (tibia) causes the legs to bow, or rickets, a deficiency of Vitamin D.

What are the signs and symptoms of bowed legs?

A child is considered bowlegged when his/her knees are wide apart or do not come together when standing with their feet and ankles together. A child with bowed legs will have a distinct space between their lower legs and knees. This may be a result of one/both of the child's legs curving outward.

What tests are used to diagnose bowed legs?

Bowed legs can sometimes be diagnosed through a physical exam. However, a doctor will sometimes need to order X-rays and/or blood tests to rule out more serious conditions or causes of bowed legs.

What to expect from bowed legs test

Your child's doctor will do a thorough physical exam of your child's lower extremity (legs). If needed, your doctor may also obtain an X-ray to assess bone alignment.

How do providers at Children's Hospital Colorado make a diagnosis?

Our doctors will evaluate your child's leg alignment, keeping in mind that that there is a range of "normal" leg alignment for each age. We will also help determine whether the alignment is physiologic, part of normal development that will improve with time and growth, or pathologic, alignment that will get worse with time and growth and may require medical or surgical treatment.

Our doctors will determine a diagnosis after a thorough assessment has been completed, which may include X-ray studies, blood tests and/or additional visits over time to watch how the legs develop.

What else could it be?

Bowed legs can also be a presentation of Blount's disease, in which the abnormal growth in the upper part of the shin bone (tibia) causes the legs to bow. Unlike bowed legs, the bowing with Blount's disease will be progressive and get worse over time. Blount's disease must be treated with bracing or surgery.

Bowed legs in a toddler could also be caused by rickets, a deficiency of Vitamin D. This rarely occurs in developed countries like the United States because many foods are fortified with Vitamin D, including milk. More commonly, rickets is secondary to a problem with absorbing or metabolizing Vitamin D and will require the involvement of an endocrinologist. This condition may require surgery when the child gets older to correct the bowing.

How are bowed legs treated?

Generally, bowed legs do not require any special shoes or braces. The bowing should improve as the child grows, typically from 15 to 18 months until about 3 years of age. The child will often develop knock-knees (where the knees come close together) during this time, but the condition should resolve around the age of 8.

If there is an alignment concern that continues past 7 or 8 years old, parents should consult a pediatric orthopedic provider to determine whether there is a need for treatment.

Bowed legs (or one bowed leg) beyond the age of 3 can indicate a leg length discrepancy. It can also be a sign of a more serious condition, such as rickets or Blount's disease.

Why choose Children's Colorado for your child’s bowed legs?

If your child's bowed legs do not correct as he or she grows, your primary care doctor may refer you to the General Orthopedics Program at Children's Colorado. This program provides highly skilled care for babies, kids, teens and young adults with lower limb (leg) issues.

Our team of pediatric experts in the General Orthopedics Program specializes in correcting complex limb deformities and limb-length discrepancies (if one leg is longer than the other, for example). Treatment can vary depending on your child's unique needs, with many options for treatment.

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